FAQs on Spinal Cord Stimulation for Post-Laminectomy Syndrome

29 Aug FAQs on Spinal Cord Stimulation for Post-Laminectomy Syndrome

Spinal cord stimulation is the most effective method to manage persistent pain associated with post-laminectomy syndrome. A perfect pain-management option for those not responsive to medical and surgical modalities, SCS therapy provides excellent pain relief by disrupting pain perception.

What is post-laminectomy syndrome?

Laminectomy is surgical procedure to treat herniated spinal disks, remove bone overgrowths choking the spinal canal, or decompress spinal nerves. It takes out the back part of the vertebral bone or lamina to create more space. However, the surgery failed to offer significant pain relief or cause new pain symptoms. This is known as post-laminectomy syndrome and leads to persistent pain in the back.

What are symptoms of post-laminectomy syndrome?

• Dull, aching pain in the spine
• Continued back pain and disability that existed prior to surgery
• Stabbing neuropathic pain
• Burning pain radiating to the leg
• Back pain during daily activities and even sleeping

How does spinal cord stimulation treat post-laminectomy syndrome?

A spinal cord stimulator is pocker chip-sized electrical device. It is connected to electrode leads through which it delivers gentle electrical impulses to the epidural area. This low-voltage electrical current impact the spinal nerves and disrupt the pain sensation transmission. The lack of pain perception by the brain leads to excellent pain relief.

How effective is SCS therapy to manage pain caused by the post-laminectomy syndrome?

According to a 2009 research report, spinal cord stimulation provides patients with post-laminectomy syndrome an exceptional option to manage pain, improve functionality, reduce dependence on painkillers, and enhance the overall wellbeing.”  A long-term study claims that SCS is 74% successful.

A 2014 report in the Neuromodulation journal found spinal cord stimulation as the most “successful and cost-effective” option to manage post-laminectomy syndrome.

Who is a candidate for spinal cord stimulator implant?

To become suitable for spinal cord stimulator implant, one must

• have chronic post-laminectomy syndrome
• have intractable chronic back pain for a long time
• have pain not relieved by other treatment modalities
• have no infection or neurological disorder

How to find out if spinal cord stimulation is beneficial for a patient?

Prior to the permanent implant, a patient undergoes trial spinal cord stimulation test to find out if the treatment is going to provide him or her significant pain relief.  The trial continues for a week and patients getting more than 50% pain relief from post-laminectomy syndrome are considered for permanent SCS implant.

How is the trial test performed?

Patients carry an external spinal cord stimulator attached to electrodes inserted into epidural place. The device provides neuromodulation based on individual patient’s intensity of pain feeling associated with post-laminectomy syndrome.

What happens during spinal cord stimulator implant?

A spinal cord stimulator and its electrode leads are placed under the skin through two incisions. While leads are place close to the spine, the SCS device is placed just above the buttock. A wire connects both. Incisions are closed after a test run confirms proper functioning of the device.

How long does it take?

Spinal cord stimulator implant to manage the post-laminectomy syndrome is completed in 2 to 3 hours and performed under general anesthesia.

What type of anesthesia is used during the implant?

General anesthesia is used during spinal cord stimulator implant.

How long do I need to stay in the hospital?

It is an outpatient procedure and patients are discharged after a brief monitoring period.

What I should not do until the recovery?

• Have rest for a week
• No shower or deep bath for 3 weeks
• No rigorous activities for 6 weeks
• Avoid exposure to sunlight and dust for a week
• No twisting and bending for 6 weeks
• No swimming, running for 6 weeks
• No driving for 4 weeks

Is spinal cord stimulation a threat to the spine in the long run?

There is no evidence until now to prove that spinal cord stimulation may cause any damage to the spine in the long run. SCS around the epidural space is regarded as safe to manage post-laminectomy syndrome without any injury to the spinal cord. However, the surgical implant may cause damage to the spine. Such injury can be avoided when the standard procedure is followed and experts perform the implant.

How often do I need to replace the SCS battery?

Spinal cord batteries last about 3 to 10 years depending on their usage for post-laminectomy pain management.

Is the spinal cord stimulator visible to others?

No, others cannot see or listen to the spinal cord stimulator in your body. It is placed inside the body without creating any detectable bulge. Also, it does not create any noise.

How is the spinal cord stimulator operated?

A small remote control enables post-laminectomy syndrome patients to operate the device and reset it as per their need.

What are the side effects of spinal cord stimulation?

• No general side effect
• Surgical complications may be there following the implant and these can avoided.
• Rare cases of spinal headache at the initial stage.

References

North RB, Kidd DH, Farrokhi F, Piantadosi SA: Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial. Neurosurgery. 2005, 56: 98-106.

Taylor RS, Ryan J, O’Donnell R, Eldabe S, Kumar K, North RB: The cost-effectiveness of spinal cord stimulation in the treatment of failed back surgery syndrome. Clin J Pain. 2010, 26: 463-469.

Zucco F, Ciampichini R, Lavano A, et al. Cost-Effectiveness and Cost-Utility Analysis of Spinal Cord Stimulation in Patients With Failed Back Surgery Syndrome: Results From the PRECISE Study. Neuromodulation 2015; 18: 266–276