Spinal Cord Stimulator

Helping Patients from North Central Arkansas & South Central Missouri

Spinal cord stimulation, also referred to as neurostimulation, is a minimally invasive procedure often used to help treat acute and chronic pain. This procedure is typically used after more conventional methods of treatment have failed, like physical therapy, medication, injection therapy, and rest. The procedure involves the application of low voltage electricity to block the spinal nerves from being able to transmit pain signals. It is intended to assist patients with pain management and potentially decrease the amount of pain medication that is normally required to lower your pain levels. This procedure may be a viable option if you are experiencing chronic pain in your hands, legs, back or feet, and have not found effective treatment from the more conventional methods. A slight electric current will be transmitted from a small, battery-powered generator to your spinal cord. This will most likely result in a slight tingling feeling, rather than pain. The procedure is meant to interrupt pain signals, thereby allowing many patients to return to a normal, active, and healthy lifestyle.

Several medical conditions commonly treated using spinal cord stimulation include:

• Neuritis/Neuropathy
• Arachnoiditis: Painful inflammation of the meninges, accompanied by scarring
• Radiculopathy: Pain that travels down your arms or legs
• Complex regional pain syndrome: Results in pain felt in the arms, hands, legs, or feet
• Failed back surgery syndrome: Pain that is still felt in the back even after spinal surgery
• Other chronic pain conditions: Stump pain, spinal cord injury, multiple sclerosis, and others

Spinal Cord Stimulation Trial Run

On the date of your appointment, please arrive at least 20 minutes prior to the start of your scheduled procedure. Our nurses will begin an IV if you will want sedation and then they will conduct a brief nurse pre-operation assessment. You will be led to the procedure room and our nurses will get you set up in a hospital bed. Then, you will be provided with nitrous oxide gas and sedation to help you become more comfortable. At this point, we place a cold cleaning solution on all our patients to lessen the risk of infection. Using x-ray guidance, your doctor will proceed to locate the procedure site and will inject a small amount of numbing medicine. The shot may sting slightly, but the pain will subside quickly. After, the doctor will place the epidural needle into the epidural space. Once the needle’s proper placement is confirmed, the doctor will insert a small electrode through the needle and into the space. The procedure is then repeated since the majority of the trials need about two electrodes to work effectively. Once the electrodes are properly situated, a representative from the spinal cord stimulator’s device will turn it on and ask you how it feels. The company’s representative will adjust the device until you report feeling a pleasant tingling feeling instead of the pain you have been experiencing. This is painless and usually takes less than 10 minutes. Afterwards, the needles will be taken out and the electrodes will be taped to your back with a few stitches. The battery will be taped to your back as well and it will still be connected to the electrodes. Then you will be given instructions on how to properly care for the device before you leave our care. This trial will last for five days before you need to return to our clinic. It is imperative that you thoroughly test the device by engaging in your normal, everyday activities and observing how effectively it works to reduce your pain. During this trial, you should continue taking pain medication as prescribed. When you return to our clinic, your doctor will take out the electrodes and put a small bandage over where they used to be located. If you report that the device reduced your pain levels by at least half, then you will be considered for permanent implantation of the electrodes.

Spinal Cord Stimulator Permanent Placement

This procedure is only conducted after the patient has reported a successful trial run, as stated previously. If you are going to receive a permanent implantation of the spinal cord stimulator from an outside doctor, please follow their instructions as they can differ from physician to physician. Permanent implantation of spinal cord stimulators is usually only conducted in operation rooms and they are typically divided into two categories: A laminotomy and a percutaneous implant.

Laminotomy

Laminotomies are usually conducted by either a neurosurgeon or an orthopedic surgeon. This procedure is typically performed in an ambulatory surgery environment or hospital setting and it requires the application of general anesthesia. The surgeon will make a small incision in the patient’s lower back to place the electrodes within it. The electrodes will be secured and attached to the patient’s spine and ligaments. A laminotomy is when a tiny amount of spinal bone is removed to make space for the electrodes. Once they are secured, they will then be sewn into position by your surgeon. After, they will connect the electrodes to the battery and sew up all skin incisions. Finally, you will be done and directed to a separate recovery area.

Percutaneous Implant

Percutaneous implants are performed by a patient’s primary pain physician. On the day of your appointment, please arrive at least 20 minutes prior to the start of your scheduled procedure. Our nurses will get you set up with an IV if you will want sedation and then they will conduct a brief nurse pre-operation assessment. You will be led to an operation room and will lie down on a hospital bed. After you are situated in the procedure room, you will be provided with nitrous oxide gas and sedation in order to help you become more comfortable. At this point in the procedure, we place a cold cleaning solution on all our patients to lessen the risk of infection. Utilizing x-ray guidance, your doctor will locate the procedure site and inject a small amount of numbing medication. It may sting slightly, but the small amount of pain will pass quickly. Then, the epidural needle will be placed into the epidural space and confirmed for proper placement. Once it is confirmed, your doctor will insert the electrode and repeat the procedure again in order to place another electrode. After the electrodes are situated, a representative from the spinal cord stimulator’s company will turn on the device and ask you to describe how you feel. Then the representative will adjust the device until you report feeling a pleasant tingling feeling. Your doctor will make a small incision on your lower back area and will attach the electrodes just under the skin. They will then connect the electrodes to the battery and sew up any other incisions. Finally, you will be taken to a separate room for recovery.

What to Expect Afterwards

You should expect slight pain or discomfort and you should continue to take your pain medications as directed. You can use over the counter pain medication and ice for short-term pain relief.

You should avoid these activities for six to eight weeks following the procedure:

• Twisting, bending, stretching, or lifting anything over five pounds above your head
• Raising your arms above your head
• Sleeping on your stomach
• Sexual activity until after your first follow up appointment with us

Regarding bathing for incision care, you are allowed to shower but you should not submerge yourself in a bath or pool until after your first follow up appointment with us. Bandages will fall off gradually after your procedure and you should leave all stitches and staples in place until after you meet with us again. Finally, make sure you observe the site of the incision at least twice daily and make sure it is kept clean and clear.

Follow Up Visit

You should return to our clinic about 10 days after the procedure in order to remove your staples and stitches. You may be required to contact the aforementioned company representative to help create a comprehensive pain management program.

When you should call your doctor:

• If you have a fever over 101 degrees and it lasts for more than half a day
• If you notice any sign of infection
• If you notice any type of wiring or metal other than the staples or stitches
• If your body develops severe lower back pain, leg paralysis, leg numbness, or loss of bladder or bowel control

For more information regarding spinal cord stimulators, please call Interventional Pain Management, a department of Baxter Regional, at (870) 508-5900.