Do you suffer from chronic neck pain, back pain, or arm and leg pain after spine surgery that just won’t go away? Do you have bothersome arm or leg pain and your doctor told you that you have neuropathy from trauma, diabetes, or peripheral vascular disease? Is your chronic pain significantly impacting your quality of life? Then, spinal cord stimulation may be a great option for you.
Spinal cord stimulation is an FDA-approved, reversible, minimally-invasive, customizable, advanced neurosurgical procedure that can significantly reduce chronic pain, reduce the amount of pain medication, and improve function and quality of life, when combined with other treatments, including medications, exercise, physical therapy, and relaxation methods.
Dr. Brian Hwang is happy to meet and discuss spinal cord stimulation with you. Dr. Hwang is a neurosurgeon who specializes in spinal cord stimulation. He has completed a prestigious fellowship in spinal cord stimulation and advanced neuromodulation therapies at the Johns Hopkins Hospital and has conducted cutting-edge research in this space.
What is a spinal cord stimulator and how does it work?
Spinal cord stimulators consist of thin wires (the electrodes) and a small, pacemaker-like battery pack (the generator). The electrodes are placed in the spine, between the spinal cord and the vertebrae, and the generator is placed under the skin, usually near the buttocks or the abdomen. Spinal cord stimulators allow people to send the electrical impulses using a remote control when they feel pain. Both the electrodes and the remote-control programs can be tailored to the person to maximize the benefit.
Spinal cord stimulation is believed to treat pain by using low level electricity to alter the way the pain signal is processed in the brain and the spinal cord. Just as rubbing a painful area reduces pain, spinal cord stimulator’s electricity is thought to drown out the pain signal and prevent the brain from detecting it. Traditional spinal cord stimulation technology uses electricity that replaces pain with gentle tingling sensation, but newer technology uses electricity that one cannot feel.
Spinal cord stimulation technology has gone through remarkable advancements since FDA’s approval in 1984. The electrodes have become more sophisticated, batteries have become smaller and more powerful, and treatment options have become more effective and customizable. As a result, outcomes have become more predictable and better.
Who is spinal cord stimulation used for?
Spinal cord stimulation is designed to treat different types of pain conditions, including:
- Back pain, especially back pain that continues after spine surgery
- Nerve pain in the arm or leg, especially if it continues after spine surgery
- Nerve pain, such as diabetic neuropathy and cancer-related neuropathy from radiation, surgery, or chemotherapy
- Post-surgical pain
- Arachnoiditis (painful inflammation of the arachnoid, a thin membrane that covers the brain and spinal cord)
- Heart pain (angina) untreatable by other means
- Chronic pain after spinal cord injury
- Peripheral vascular disease
- Complex regional pain syndrome
- Pain after an amputation
- Visceral abdominal pain and perineal pain
Each person is different, but generally, those who benefit the most from spinal cord stimulation are those who:
- Have failed to get sufficient pain relief with medications, less-invasive therapies, or surgeries
- Do not have psychiatric disorders that would decrease the effectiveness of the procedure
Spinal Cord Stimulator Surgery
Spinal cord stimulation requires two procedures to test and implant the device: the trial and the implantation. Only those who have a successful trial will get the implant procedure. Unlike spine surgery, both the spinal cord stimulation trial and the implant are reversible procedures. In carefully selected people, trials and implantations can be highly successful in controlling chronic pain.
Spinal Cord Stimulator Trial
Everyone first undergoes a trial. During a trial, you will receive a temporary device test out. A Spinal Cord Stimulator trial is important because it helps one find out what it’s like to have a spinal cord stimulator without having the entire system placed under the skin and see if it helps with the pain.
This trial procedure typically requires only one incision in your lower back to place the electrodes. The generator/battery will be outside the body, typically on a belt, you’ll wear around your waist. For about a week, you will evaluate how well the device reduces your pain. The trial is considered a success if you experience a 50% or greater reduction in pain level.
If unsuccessful, the wires can easily be removed in the clinic without damage to the spinal cord or nerves. If successful, surgery is scheduled to permanently implant the device.
Spinal Cord Stimulator Implantation
During the permanent implantation procedure, the generator is placed underneath the skin and the trial electrodes are replaced with sterile electrodes. Unlike the trial electrodes, these will be anchored by sutures to minimize movement.
The implantation can take about 1-2 hours and is typically performed as an outpatient procedure.
After the local anesthesia has been administered, one incision (typically along your lower abdomen or buttocks) will be created to hold the generator and another incision (along your spine) to insert the permanent electrodes. The incisions are about the length of a driver’s license.
Spinal Cord Stimulator Recovery
Most people go home the same day. For several days after surgery, your incisions may be painful. Try not to stretch, twist or reach, which could pull at the incisions. Dressings will be placed over the incision sites, which can be removed after about 3 days. In most cases, incisions heal within about 2-4 weeks after surgery. Generally, lighter activity is recommended for about 2 weeks after surgery. Most people go back to work and drive again 2 weeks after the implantation procedure.
Spinal Cord Stimulator Complications
Complications of spinal cord stimulator surgery are rare, but no procedure is without risk. A small percentage of people may experience:
- Infection, which may occur in the first 2-8 weeks.
- Bleeding
- Device migration – the electrodes move from their original location and the stimulator doesn’t block pain as effectively. This often requires a follow-up surgery to put the electrodes back in the proper spot.
- Device damage – a fall or intense physical activity breaks the stimulator
- Spinal fluid leak – The dura mater surrounds the spinal cord. If a needle or electrode goes too deep and pierces the spinal cord covering, spinal fluid may leak out. These punctures can cause severe headaches. Most of the time, the fluid leak will stop on its own. In severe cases, you may need a blood patch.
- Spinal cord trauma – Although extremely rare, spinal cord stimulator insertion can cause nerve injury and paralysis
Living with a Spinal Cord Stimulator
Generally, the pain relief provided by spinal cord stimulators allows patients to do much more than they could before surgery, but there are certain restrictions to be mindful of.
Can I have X-rays and CT scans with a spinal cord stimulator?
So long as your spinal cord stimulator is powered off, X-rays and CT scans are generally safe. Before undergoing any scan, always let your doctor, nurse or technician know you have a spinal cord stimulator.
Are spinal cord stimulators MRI compatible?
No, MRIs are not always safe for those with spinal cord stimulation devices. Many of the newer devices are compatible but don’t assume that yours is. Make sure to ask the surgical team about the specifics of your stimulator before getting an MRI. If your device is not MRI compatible, MRIs can cause serious injury.
Will my spinal cord stimulator set off airport security?
Yes, airport security gates will detect your stimulator, but you will have an identification card that may allow you to bypass the machine.
Some people find that airport security gates cause uncomfortable (but harmless) interference with their stimulators. If you cannot avoid passing through the security screener, turn off your device before stepping through.
Can I drive with a spinal cord stimulator?
No, you should power off your stimulator when you’re driving or operating heavy machinery, as sudden changes in stimulation levels could cause distraction.
Can I swim with a spinal cord stimulator?
Swimming is fine with a permanent, implanted generator, but you cannot get your temporary stimulator wet. You will need to avoid baths and showers during that short trial period.
Can a spinal cord stimulator be removed?
Yes, a spinal cord stimulator can be removed safely if you are not satisfied with the level of pain relief it provides or if there is an infection or mechanical problem with your system.