Spinal Cord Stimulation (SCS)
Spinal cord stimulation (also called SCS) uses electrical impulses to relieve chronic pain of the trunk, arms and legs. It is believed that electrical impulses block pain signals within the spinal cord and prevent these impulses from reaching the brain.
SCS candidates include people who suffer from neuropathic (nerve injury) pain and for whom conservative treatments have failed. This advanced technology can be easily trialed, allowing the patient to experience pain relief from stimulation prior to making any decision to have a perment pain control system surgically implanted.
Trial Implantation
The injection site is anesthetized. One or more insulated wire leads are inserted through an epidural needle into the space surrounding the spinal cord, called the epidural space. The trial procedure is similar to an epidural steroid injection and there is no incision and no surgery required. IV conscious sedation or general anesthesia can be administered as the patient wishes.
Find the Right Location
Electrodes at the end of the lead wire produce electrical pulses that stimulate the spinal cord and spinal nerves, blocking pain signals. The patient may sometimes be asked to provide feedback to help the physician determine where to place the stimulation leads to best block the pain. The leads are connected to an external trial stimulator, which will be used for approximately one week to determine if SCS will help the patient.
Determine Effectiveness
If the patient and physician determine that the amount of pain relief is acceptable, the system may be permanently implanted. At the end of the trial implantation, the leads are removed.
Permanent Implantation
We think of spinal cord stimulation implant as similar to implant of a cardiac pacemaker – both devices include wires and batteries, but spinal cord stimulation is targeted to the spine rather than the heart. The permanent implantation may be performed while the patient is under sedation or general anesthesia. First, one or more permanent leads are inserted through an epidural needle placed through a small incision in the midline spinal area and advanced into the predetermined location in the epidural space.
Generator Implantation
Next, a small incision is created in the upper buttock or flank, and the implantable pulse generator (IPG) battery is positioned beneath the skin. It is most often implanted in the buttocks or the flank. The leads are then tunneled beneath the skin, from the spine to the IPG pocket and connected to the IPG battery.
End of Procedure
The internal pulse generator (IPG/battery) is programmed with an external wireless programmer. The patient can use the programmer to turn the system on or off, adjust the stimulation power level and switch between different programs.
After SCS Implementation
After surgery, patients may experience mild discomfort and swelling at the incision sites for several days.
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