Spinal Cord Stimulation

Your doctor may recommend spinal cord stimulation to treat chronic pain that has not responded to less invasive treatments, such as medications, physical therapy, and spinal injection. Spinal cord stimulation treats chronic pain from the following conditions:

• Arachnoiditis, which is inflammation of a lining that surrounds and protects the brain and spinal cord. Arachnoiditis can cause spasms, muscle cramps, and stinging and burning pain in the lower back or legs.

• Degenerative conditions including arthritis and spinal stenosis, which can cause chronic leg pain, called sciatica, or arm pain

• Complex regional pain syndrome, which is a nerve disorder that causes burning pain, usually in the arms, hands, legs or feet

• Failed back surgery syndrome and post-laminectomy syndrome, which is persistent or recurrent lower back or leg pain following spinal surgery

• Nerve damage, neuropathy, and neuritis from damage to the outer sheathing or protective covering, called myelin, of nerve cells that can cause burning pain, pricking sensations, and sensitivity to touch

A neurosurgeon implants a spinal cord stimulation device and manages the device after implantation. Neurosurgeons specialize in the medical and surgical care of people with diseases and conditions of the brain and nervous system.

Your spinal cord stimulation implantation will be performed in a hospital or clinic. 

Spinal cord stimulation involves two phases. The first phase is a temporary trial procedure to see if spinal cord stimulation effectively relieves your pain. The trial procedure also helps your surgeon determine what type of therapy and stimulation settings are best for you. The second phase involves implanting a permanent spinal cord stimulator. 

The trial procedure generally involves these steps: 

1. You will remove your clothing, all jewelry, and accessories and dress in a patient gown.

2. Your care team will give you a light sedative to relax you. Sometimes your team will use general anesthesia to put you in a deep sleep.

3. Your surgeon will clean your lower back and inject a local anesthetic under the skin to numb the area.

4. Your surgeon will make a small incision in your lower back or insert a special needle into the space around your spinal cord, called the epidural space.

5. Your surgeon will insert one or more wires, called leads, into the epidural space through the needle or incision.

6. Your surgeon will ask you questions about your pain to help determine the best placement of the leads. You will be awake during this part of the procedure.

7. Your surgeon connects the leads to a temporary stimulator device that you wear on a belt for about a week. The device produces electrical pulses and sends them through the leads into your spinal cord to block pain signals from reaching the brain.

8. Your team will close the incision and apply a dressing.

9. Your care team will teach you how to program your spinal cord stimulator for optimal pain relief before you go home.

If the trial spinal cord stimulation is successful, your surgeon will implant permanent leads using a similar procedure. Sometimes general anesthesia is necessary for the permanent implantation procedure. Your surgeon makes a small incision in your buttocks or abdomen to implant a permanent stimulator device under the skin. 
Will I feel pain?

Your comfort and relaxation is important to both you and your care team. You may feel a brief pinch, discomfort or stinging when your doctor numbs the surgical area. Your provider will give you pain and sedative medications as needed so that you stay comfortable. Tell your care team if you are uncomfortable in any way.

Any procedure involves risks and potential complications. Complications may become serious in some cases. Complications can develop during the procedure or your recovery. Risks and potential complications of a spinal cord stimulation include: 

• Adverse reaction or problems related to sedation or anesthetic medication such as an allergic reaction and problems with breathing

• Formation of scar tissue around a lead

• Headache due to leakage of spinal fluid

• Infection

• Interaction of the device with other tests or devices including MRI, pacemakers, and ultrasound machines

• Problems with the stimulation device including stopping, working intermittently, and breakage or movement of the lead requiring surgery

• Stimulation becoming less effective, affecting the wrong location, or becoming over-stimulating

Reducing your risk of complications

You can reduce the risk of certain complications by following your treatment plan and: 

• Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery. This generally includes avoiding lifting, bending, stretching and twisting. Your doctor may encourage light exercise such as walking.

• Informing your doctor if you are nursing or there is any possibility that you may be pregnant before your procedure

• Notifying your doctor immediately of any concerns such as headaches, itching, numbness, tingling, fever, or increase in pain

• Following your doctor’s instructions exactly for avoiding other devices that can damage your spinal cord stimulator such as MRI, ultrasound machines, defibrillators, electrocautery, diathermy, and cardiac pacemakers

• Taking your medications exactly as directed

• Telling all members of your care team if you have any allergies

• Telling all your healthcare providers, including your dentist, that you have a spinal cord stimulation device

You are a very important member of your own healthcare team. The steps you take before your spinal cord stimulation implantation can improve your comfort and outcome.

You can prepare for a spinal cord stimulator implantation by:

• Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

• Learning about the procedure and asking any questions you may have

• Taking or stopping medications exactly as directed

Questions to ask your doctor

Preparing for spinal cord stimulator implantation can be stressful. It is common to forget some of your questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before your procedure and between appointments.

It is also a good idea to bring a list of questions to your appointments. Questions can include:

• Why do I need spinal cord stimulation? What are my other options for treating my chronic pain?

• How long will the procedure take? When can I go home?

• How do I program my stimulator? How long will I use the trial stimulator?

• What restrictions will I have after the procedure? When can I return to work and other activities?

• What kind of assistance will I need at home? Will I need a ride home?

• What are the risks of spinal cord stimulator implantation?

• How should I take my medications?

• How will you treat my pain?

• When should I follow up with you?

• How should I contact you? Ask for numbers to call during and after regular hours.

Knowing what to expect after spinal cord stimulation can help you get back to your everyday life as soon as possible.

Your doctor will likely recommend that you avoid lifting, bending, stretching and twisting. Walking and other light exercise activities are often encouraged. Follow your doctor’s instructions for which activities are best for you.

How will I feel after spinal cord stimulation?

You may a have tingling feeling when your spinal cord stimulator is working, but you should not have pain. Tell your doctor if you are having pain.

You may also have mild soreness or tenderness in your lower back for a couple of days from the incision or needle insertion. Your doctor will advise you about what pain medication you can take.

Acetaminophen (Tylenol) is often a sufficient pain reliever. You should only take nonsteroidal anti-inflammatory drugs (NSAIDs) as directed by your doctor. People with certain conditions should not take NSAIDs. 

When can I go home?

You will likely go home the same day of your spinal cord stimulator implantation. Sometimes an overnight hospital stay is necessary.

When should I call my doctor?

You should keep your follow-up appointments after your procedure Contact your doctor if you have any concerns between appointments. Call your doctor right away if you have:

• Bleeding

• Fever (you should not have any fever after spinal cord stimulator implantation)

• Headache

• Leakage of fluid or blood from the spinal cord stimulator implantation site in the lower back

• New or unexplained symptoms

• Pain that is not controlled by your pain medication, new pain, or increase in pain

• Problems with the stimulation device including overstimulation or understimulation

• Rash or skin irritation

• Swelling, warmth or redness at the procedure site in the lower back

How might spinal cord stimulation affect my everyday life?

Spinal cord stimulation can relieve or improve the symptoms of chronic pain so you can lead a more active, healthy life. You may also need less pain medication or a milder type of pain medication. Spinal cord stimulation also requires certain lifestyle changes including:

• Avoiding MRIs, ultrasound machines, defibrillators, electrocautery, diathermy, and cardiac pacemakers. These tests and devices can damage your stimulator

• Carrying the identification card your doctor gives you at all times. The card identifies you as a spinal cord stimulation patient. This avoids security problems because your spinal cord stimulator may set off security systems such as metal detectors at airports.

• Keeping your stimulator control device at least two inches away from watches, clocks, and items with magnetic strips including credit cards, video or audiocassettes, and computer disks. The stimulator can damage these items.

• Not driving or using heavy or dangerous equipment while the stimulator is turned on

• Turning off your stimulator before walking through anti-theft devices in stores. These security systems may temporarily increase stimulation if your stimulator is turned on.