What is a spinal cord stimulator (SCS)?

A Spinal Cord stimulator (SCS) is a medical device that is surgically implanted in a person’s body to help manage chronic pain. It works by sending electrical impulses to specific areas of the spinal cord, which disrupt the pain signals traveling from the spinal cord to the brain. This can lead to a reduction in the perception of pain.

Which conditions are treated with SCS?

A Spinal Cord Stimulator (SCS) is considered for individuals with chronic pain conditions that have not responded well to other treatments. Some of the conditions that may be treated with a spinal cord stimulator include:

• Complex Regional Pain Syndrome (CRPS): This is a chronic pain condition characterized by severe pain, swelling, and changes in the skin. It often affects an arm or a leg, and it can develop after an injury or surgery.
• Neuropathic Pain: This includes conditions where pain arises from damage to or dysfunction of the nervous system. This can be due to conditions like diabetic neuropathy, nerve injury, or conditions like peripheral neuropathy.
• Failed Back Surgery Syndrome (FBSS): FBSS refers to persistent pain following one or more surgical procedures on the spine. It’s a common condition where a spinal cord stimulator can be considered.
• Ischemic Limb Pain: This type of pain arises from reduced blood flow to a limb, often due to conditions like peripheral arterial disease.

How do spinal cord stimulators work?

Spinal cord stimulators (SCS) work by sending electrical impulses to specific areas of the spinal cord, which disrupt the pain signals traveling from the spinal cord to the brain. 

A small device, similar to a pacemaker, is surgically implanted under the skin. This device contains a battery and electronic circuitry. It’s usually placed in the abdomen or buttock. Thin wires, called electrode leads, are inserted into the epidural space near the spinal cord. These leads are carefully positioned to target the specific nerves associated with the pain.

The electrical impulses generated by the stimulator interfere with the transmission of pain signals to the brain. This can lead to a significant reduction in the perception of pain. The sensation created by the stimulation is often described as a mild tingling or buzzing, which can “override” or mask the pain.

What is the process to insert a spinal cord stimulator?

The insertion procedure for a spinal cord stimulator (SCS) involves several steps, and it is typically performed by a skilled and experienced pain management specialist or surgeon. Here is an overview of what the procedure entails:

1. Anesthesia: General anesthesia or a local anesthetic with sedation may be administered to ensure the patient is comfortable and pain-free during the procedure.
2. Lead Placement: Using fluoroscopic guidance (live X-ray imaging), the surgeon will insert thin, insulated wires (electrode leads) through a needle or small incision in the back. These leads are carefully positioned in the epidural space near the spinal cord. The exact placement is crucial for targeting the specific nerves associated with the patient’s pain.
3. Trial Stimulation: Before permanently implanting the stimulator device, a temporary external generator may be connected to the leads. This allows the patient to experience the stimulation and determine if it provides adequate pain relief. The trial period typically lasts for a few days to a week.
4. Device Implantation: If the trial is successful and the patient experiences significant pain relief, a small incision will be made in the abdomen or buttock to create a pocket for the stimulator device. The device is then implanted and connected to the leads.

How long does a spinal cord stimulator take to start working?

Some patients may experience immediate relief during the trial period, while others may require more time to adjust the settings for optimal pain control.

After the permanent implantation of the SCS device, there may be an adjustment period during which the patient and their healthcare provider fine-tune the settings to achieve the best pain relief. This may take several weeks to a few months.

What are the risks associated with a spinal cord stimulator?

While spinal cord stimulators (SCS) can be effective for managing chronic pain, like any medical procedure, they come with potential risks and complications. Some potential complications include:

• Infection: Any surgical procedure carries a risk of infection at the site of incision. This can occur in the area where the leads are placed or where the stimulator device is implanted.
• Bleeding or Hematoma: There is a risk of bleeding during the procedure, which could lead to the formation of a hematoma (a collection of blood outside blood vessels).
• Lead Migration or Displacement: The leads, which are inserted near the spinal cord, could shift or move from their original placement, potentially reducing the effectiveness of the stimulation.
• Dural Puncture: In rare cases, the dura mater (the protective covering of the spinal cord) may be punctured during lead placement. This can lead to cerebrospinal fluid leakage and may require additional medical intervention.

Who should avoid a spinal cord stimulator?

While spinal cord stimulators (SCS) can be an effective treatment for many individuals with chronic pain, there are certain situations or conditions where SCS may not be recommended or may require careful consideration.These may include:

• Pregnancy: The use of SCS during pregnancy is a topic of ongoing research and discussion. In general, SCS is not typically recommended for pregnant individuals due to potential risks to both the mother and the fetus.
• Coagulopathy or Bleeding Disorders: Individuals with bleeding disorders or those taking anticoagulant medications may be at increased risk of bleeding during the surgical procedure, making SCS implantation more challenging. You may be told to hold your anticoagulation before the procedure.
• Inadequate Pain Relief During Trial Period: If a person does not experience significant pain relief during the trial period, it may be an indication that SCS may not be the most effective treatment option for their specific condition.
• Inability to Use the Device: Some individuals may have difficulty operating the device due to physical or cognitive limitations. In such cases, alternative pain management options may be considered.
• Inability to Participate in Follow-Up Care: Regular follow-up appointments with healthcare providers are essential for the long-term success of SCS therapy. If a person is unable to commit to this follow-up care, it may impact the effectiveness of the treatment.

Ultimately, the decision to proceed with a spinal cord stimulator is made on an individual basis after a thorough evaluation by a pain management specialist.

Sources

Sdrulla AD, Guan Y, Raja SN. Spinal Cord Stimulation: Clinical Efficacy and Potential Mechanisms. Pain Pract. 2018;18(8):1048-1067.

Song JJ, Popescu A, Bell RL. Present and potential use of spinal cord stimulation to control chronic pain. Pain Physician. 2014;17(3):235-246.

Garcia K, Wray JK, Kumar S. Spinal Cord Stimulation. [Updated 2023 Apr 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553154/

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