Spinal Cord Stimulators

What is a Spinal cord stimulator?

A Spinal cord stimulator (neurostimulator) is device positioned near the spine which delivers electrical pulses to the spinal cord to block pain signals from traveling up to the brain. In the treatment, electrodes are surgically placed to the spinal nerves and connect to a spinal cord stimulator (small battery operated device) that then sends electrical pulses to the nerves to mask pain.

Spinal Cord Stimulation does not eliminate the source of pain, it simply changes the way the brain perceives it. Spinal cord stimulator candidates include people who suffer from neuropathic pain and for whom conservative treatments have failed.

Prior to the Procedure:

Initially, you will be given a trial procedure with an external Spinal cord stimulator so you and your surgeon can assess the benefit of the stimulator before it is implanted. You will be fitted with a trial device that works like an implanted system but can be easily removed. The trial is approximately 7- 14 days, and is designed to determine whether a Spinal cord stimulator will be beneficial in managing your pain. You are encouraged during the trial to undertake your regular daily activities to identify what benefit it would be to you.

What Will Happen?

  1. The trial involves a procedure in an operating theatre under sedation whereby stimulator leads (thin, flexible wires) are placed near the spinal cord (in the epidural space), via a special needle.
  2. The leads are positioned precisely using x-rays for guidance.
  3. The leads are connected to an external wireless neurostimulator that’s secured to your back during the trial. (These leads are easily removed at the end of the trial)

Post Procedure:

  • Post operatively patients are monitored for several hours. If pain is well controlled and the patient is safe to do so they can usually return home the same day as the procedure takes place. Some patients may be required to stay overnight for observation if your surgeon feels this is necessary
  • You will require a driver as you will not be able to drive following
  • You should plan to take it easy for a day or so after the procedure. You will be able do most activities but is generally advised to avoid a lot of bending or twisting of the spine.

What happens next?

  • You will need to return to the clinic following the trial period to determine if the effectiveness of the Spinal cord stimulator
  • Your surgeon will help you decide if you should proceed with the spinal cord stimulator implant.
  • The next step is to schedule surgery to get the permanent system implanted.

If you and your doctor decide that Spinal cord stimulation is right for you, you may choose to have a system implanted to help you manage your pain more effectively. To receive a device, you will have a surgical procedure that is typically performed in a hospital.

A spinal cord stimulation system consists of two implanted components:

  • Neurostimulator — Rechargeable or non-rechargeable implanted power source that generates electrical pulses according to programmable neurostimulation parameters and features
  • Lead — A set of thin wires with a protective coating and electrodes near the tip (percutaneous lead) or on a paddle (surgical lead). The electrodes transmit the electrical pulses to the stimulation site

Prior to the procedure:

Once your admission has been arranged you will be notified of the details in writing. Prior to your admission to hospital we will contact you by phone to confirm all of your admission details.

You will be required to fast (NIL BY MOUTH – including water) for 6 hours prior to surgery.

If you are on aspirin or blood thinning medication such as Disprin, Plavix and Asasantin; or fish oil or krill oil you need to cease this medication 7 days prior to your admission.

The anaesthetist will talk with you and explains effects of anaesthesia and the risks.

Before your procedure, your doctor will likely discuss with you:

  • What type of generator you will receive/ What type of leads they will use
  • Where the generator will be implanted

What Will Happen?

  1. You will be positioned on the operating room table—most likely on your stomach
  2. An incision on your back and place the electrode leads (medical wires) that deliver the stimulation into the epidural space of your spinal cord with the aid of fluoroscopy (a type of X-Ray)
  3. Make a second incision and create a pocket under the skin that is large enough to hold the neurostimulator.
  4. Once the leads are placed, the generator will be implanted
  5. When the implant procedure is complete, you will be moved to a recovery area to rest until your doctor decides you are alert and well enough to leave the hospital.

Post Procedure instructions:

  • Before you leave the hospital, your doctor will give you instructions on how to care for your incisions and what activities you should avoid during your recovery. They will also show you how to use the programmer to adjust your neurostimulation therapy.
  • You may experience pain at the SCS implant site after the surgery. To allow time for healing, your doctor may recommend that you restrict your activity. You may need to avoid lifting, bending, and twisting movements.
  • You should not drive a motor vehicle or operate heavy machinery your neurosurgeon gives you the go ahead.
  • Your surgeon will see you in the clinic approximately 4-6 weeks after your surgery. Your surgeon and/or device representative will work with you to fine-tune adjustments to your spinal cord stimulator.