Spinal Cord Stimulator Implant Trial
Spinal cord stimulation (also called SCS) uses electrical impulses to relieve chronic pain of the back, arms and legs. It is believed that electrical pulses prevent pain signals from being received by the brain. SCS candidates include people who suffer from neuropathic pain and for whom conservative treatments have failed.
FAQs on Spinal Cord Stimulation for Failed Back Surgery
Spinal cord stimulation is an effective way to treat chronic pain following failed back surgery. It offers significantly better results in managing pain and disability than interventional techniques. SCS is also a cost-effective way to treat failed back surgery syndrome in the long run.
What is failed back surgery syndrome?
Failed back surgery syndrome occurs when spinal surgery fails to achieve the desired result and chronic back continues to be there. Patients may have new symptoms or continuation of previous symptoms even after the surgical treatment.
Why does back surgery not work for all?
About 20% Americans undergoing surgical treatment for chronic back pain experience failed back surgery syndrome. While many experience pain relief after back surgery, some patients continue to have back pain and added leg pain. The reason is attributed to non-specific injury, failure to address destabilized spinal joint, pinched nerves, recurrent disc herniatio, and altered joint mobility completely, formation of scar tissues, or development of new anatomical lesion.
What are symptoms of failed back surgery 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
How effective is spinal cord stimulation for failed back surgery syndrome?
The effectiveness of spinal cord stimulation for failed back surgery syndrome varies between 50% to 90%. According to a long-term study, it is more than 74% successful. A 1991 study claimed at least “53% pain relief at 2.2 years and in 47% at 5 years. It also highlighted huge improvements in functional restoration due to SCS therapy. Another study termed spinal cord stimulation as an effective alternative to spine re-operation.
A 2009-study listed SCS therapy benefits both for pain relief and secondary improvement in “functional status, psychological status, return to work, and reduction in opioid intake.” Neuromodulation journal published a report in 2014 asked failed back surgery syndrome to go for spinal cord stimulation to have more successful and cost-effective treatment.
How does spinal cord stimulation treat failed back surgery syndrome?
A spinal cord stimulator is a battery-powered device programmed to emit low-voltage electrical current. These pulses alter the functions of spinal nerves and interrupt their ability to carry pain sensation. Thus, it blacks out pain transmission and blocks feeling of pain.
What is a spinal cord stimulator?
A spinal cord stimulator is an electrical device with four major parts.
- A battery-powered pulse generator that is implanted (main unit)
- Electrode leads attached to the main unit deliver electrical pulses to the spinal column
- Extension wire connecting pulse generator with electrode lead
- A remote control unit
How often do I need to replace the battery?
Batteries of spinal cord stimulator last between 5 to 10 years depending on the usage.
Who is a candidate for spinal cord stimulator implant?
A patient with failed back syndrome can consider spinal cord stimulation therapy if he or she has
- Intractable chronic back and leg pain unresponsive to available alternatives
- Surgical benefit is not there
- Significant pain for months
- Pain is related to back surgery and radiating to legs
How will a doctor know if a patient is fit for spinal cord stimulation?
Doctors carry out a trial test before implant to test if spinal cord stimulation is beneficial for a patient with failed back surgery syndrome. The device is wrapped around the waist and a catheter is attached to it to deliver electrical pulses to the spinal column. If the patient experiences more than 50% pain relief over a period of 7 days, he or she is considered for spinal cord stimulator implant.
What happens during spinal cord stimulator surgery?
The implant involves surgical placement of the spinal cord stimulator under the skin. It is attached to electrode leads through a wire that passes through soft tissues. The device is tested with the remote unit and incisions are closed.
The procedure takes about 2 to 3 hours and performed under general anesthesia.
What can I expect after the implant?
Patients experience immediate pain relief from failed back surgery syndrome. However, there will be bruising, discomfort, and soreness at the incision site.
Patients are barred from driving for 4 weeks and from rigorous activities for 6 weeks.
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?
In most cases, the procedure is performed in an outpatient setting. Patients are discharged within a few hours. However, in extreme cases, your doctor may recommend overnight hospital stay.
Does spinal cord stimulation damage the spinal cord in the long run?
No, spinal cord stimulation is not a threat to the spine. However, the implant and revision surgeries placing the lead may cause spinal injury unless performed by an experienced doctor.
Will people notice the spinal cord stimulator?
The spinal cord stimulator is implanted in the lower abdomen area and does not make any noise. Patients carry it without any discomfort or noise.
Is it covered by insurance or Medicare?
About 80% of the cost of spinal cord stimulator is covered under Medicare. For insurance coverage, contact your insurer. Most of the insurance providers cover the cost.
What are risks associated with spinal cord stimulation?
The procedure is safe and effective to manage failed back syndrome. However, the risks of surgical complications, scar tissue formation, and infection exist just like any other surgical procedure. In rare cases there will be spinal headache due to cerebrospinal fluid leakage in the epidural area.
References
Kumar K, Nath R, Toth C. Spinal cord stimulation is effective in the management of reflex sympathetic dystrophy. Neurosurgery. 1997; 40: 503-509.
Frey ME, Manchikanti L, Benyamin RM, et al. Spinal cord stimulation for patients with failed back surgery syndrome: a systematic review. Pain Physician. 2009 Mar-Apr;12(2):379-97.
Taylor RS, Taylor RJ: The economics of failed back surgery syndrome. Br J Pain. 2012, 6: 140-141.
North RB, Ewend MG, Lawton M, et al. Failed Back Surgery Syndrome: 5-Year Follow-Up after Spinal Cord Stimulator Implantation. Neurosurgery. June 1991;28(5):692-9 ·
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.
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.
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