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Home » Spine Procedures » How Does a Spinal Cord Stimulator Implant Work?

How Does a Spinal Cord Stimulator Implant Work?

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How does a spinal cord stimulator implant work?

Although the causes are still being understood by medical researchers, spinal cord stimulation is a form of treatment that offers pain relief for a number of conditions. It works by sending a gentle electrical current into the epidural space near the spinal cord, which then disrupts pain signals traveling to the brain. There are different methods for performing this type of therapy, but the most common is a surgical procedure to place a spinal cord stimulator implant inside of the body.

Chronic pain related to a spine condition, diabetes, heart pain, complex regional pain and other conditions or illnesses can be extremely difficult to live with. While there are effective conservative treatment methods, many people attempt these therapies for weeks or months without finding sufficient relief. In situations where a more intensive surgery is either undesirable or the patient is not a viable candidate, a spinal cord stimulator implant can be an effective alternative.

To help you better understand how a spinal cord stimulator implant works and how surgeons place the implanted device, USA Spine Care is sharing the following informative article. We want to help patients become more engaged in the treatment process and make more informed decisions about their care. Please let us know if you have any questions or would like to learn more about finding relief.

Spinal cord stimulator device basics 

The fundamental design of a spinal cord stimulator implant is a pair of electrodes that are attached to the epidural space of the spinal cord near a painful area. These electrodes are attached by thin wires to a power source, or generator. While the generator can be placed outside the body, such as for a spinal cord stimulator trial period, it is typically placed inside as an implanted device.

For generators that are implanted, there are two primary types:

 

  • Conventional — This is a battery-operated spinal cord stimulator implant that does not need to be recharged. It is typical for conventional implanted devices to work for three to five years before needing a replacement. 
  • Rechargeable — Similar to the conventional generator, a rechargeable implant sends a gentle pulse to the electrodes near the spinal cord to disrupt pain signals. The primary difference is that it uses a rechargeable battery. This means that it can generate more power if needed, while also not requiring replacement.

 

The type of device used depends on a number of factors, including the location of pain and the surgeon performing the procedure. A key aspect of a positive outcome is for the surgeon to create a successful trail for the wiring between the electrodes and the generator.

The other essential component of a spinal cord stimulator implant is the external control device. This allows the patient to modify the electrical current according to the level of pain signals being experienced. Physicians can provide instruction and feedback on optimal use, including turning the device off while driving or operating machinery.

Spinal cord stimulator implant surgery overview

For patients receiving a spinal cord stimulator implant, the first step will be a trial period to determine if this form of treatment will be effective. This phase typically lasts around a week and involves the surgeon placing the electrodes and lead wires and attaching them to an external generator. The trial procedure is less extensive than even the minimally invasive permanent procedure, often involving little more than a couple of X-ray guided injections.

During this time, patients can learn how the controls work and determine the amount of relief they experience from spinal cord stimulation. It is usually recommended to keep a log of symptoms and the levels of stimulation that offer effective relief. Using this information, the surgeon and patient can work together to determine if a permanent spinal cord stimulator implant is the next phase.

If the answer is yes, an outpatient procedure will be scheduled. First the surgeon will replace the trial electrodes with permanent ones, if needed. Next, he or she will place the implanted device in either the abdomen or lower back depending on optimal placement for the patient and condition. After that, the surgeon will create a successful trail under the skin between the electrodes and the generator. This successful trail is necessary for the electrical signal to travel safely to the spinal cord, thereby disrupting pain signals to the brain.

The surgeon will then close the incisions once the procedure is complete.

Are there any risks associated with spinal cord stimulator implants?

Complications associated with spinal cord stimulator implants are rare, but any type of procedure has some level of risk. Like many surgeries, one of the primary risks comes in the form of surgical site infection, which is typically reduced for outpatient procedures, particularly in ambulatory surgery centers.

Since it is an implanted device with a power source, patient injuries such as falls can present the risk of device damage. Patients suffering any type of injury should always inform treatment professionals that they have a spinal cord stimulator implant.

To decrease the risk of any complication, patients should closely follow any and all postoperative instructions and attend required follow-up visits. While spinal cord implant surgery is a minimally invasive procedure with a less extensive recovery than other types of spine surgery, rushing back to activities ahead of guidelines may result in problems.

More information about spinal cord stimulator implants

At USA Spine Care, our caring and dedicated surgical team has decades of combined experience in performing spinal cord stimulator procedures. If you’re suffering from chronic pain and want to find out if our state-of-the-art procedures are right for you, contact us today.

Call toll free 1-866-249-1627.

Spinal Cord Stimulator - People Also Ask

Spinal cord stimulator implants are covered by Medicare and are billed under:

  • Percutaneous Leads and Extensions
    63650 Percutaneous implantation of neurostimulator electrode array, epidural
    63661 Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed
    63663 Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed
  • Paddle Leads
    63655 Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural
    63662 Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed
    63664 Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed
  • Stimulators
    63685 Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling
    63688 Revision or removal of implanted spinal neurostimulator pulse generator or receiver
  • Analysis and Programming
    CPT codes 95970–95973 are used to report electronic analysis services. These are not considered medically necessary when provided at a frequency more often than once every 30 days. More frequent analysis may be necessary in the first month after implantation.

Published studies of spinal cord stimulation show good to excellent long-term relief in 50 to 80% of patients suffering from chronic pain. One study reports that 24% of patients improved sufficiently to return to gainful employment or housework with stimulation alone or with the addition of occasional oral pain medication.

Unlike a spinal fusion, a spinal cord stimulator surgery is reversible. If a patient decides at any time to discontinue, the electrode wires and generator can all be removed.

Spinal Cord Stimulation is an option for those suffering from chronic, intractable pain of lower back and/or limbs including unilateral or bilateral pain associated with the following conditions:

  • Failed Back Surgery Syndrome (FBSS)
  • Radicular pain
  • Post-laminectomy pain
  • Multiple back surgeries resulting in continued or worsening pain
  • Unsuccessful vertebral disk surgery
  • Degenerative Disk Disease
  • Peripheral causalgia
  • Epidural fibrosis
  • Arachnoiditis
  • Complex Regional Pain Syndrome (CRPS)
  • Causalgia

No surgery is without risks. General complications of any surgery include bleeding, infection, blood clots, and reactions to anesthesia. Specific complications related to SCS may include:

  • Undesirable changes in stimulation (can possibly be related to cellular changes in tissue around electrodes, changes in electrode position, loose electrical connections, and/or lead failure)
  • Epidural hemorrhage, hematoma, infection, spinal cord compression, and/or paralysis (can be caused by placing a lead in the epidural space during a surgical procedure)
  • Battery failure and/or battery leakage
  • Cerebrospinal fluid leak
  • Persistent pain at the electrode or stimulator site
  • A pocket of clear fluid (seroma) at the implant site. Seromas usually disappear by themselves but may require a drain.
  • Lead migration, which can result in changes in stimulation and reduction in pain relief
  • Allergic response to implant materials
  • Generator migration and/or local skin erosion
  • Paralysis, weakness, clumsiness, numbness, or pain below the level of implantation

In a spinal cord stimulator trial, temporary electrodes are placed and then the patient uses an external device to generate electrical current. The electrodes are placed under x-ray guidance with the patient lying on his belly. A local anesthetic is used to numb the skin and deeper tissues. The electrical wire or lead contains a series of four to eight evenly spaced electrodes that can be programmed to generate an electrical field. A spinal cord stimulator trial period is at least 5 to 7 days. This gives you time to test the device and evaluate its effectiveness managing your pain at rest and during activity

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