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Spinal Cord Stimulator Surgery for Chronic Back Pain


Spinal cord stimulator surgery for chronic back pain

Although spinal cord stimulator therapy can treat a wide range of conditions, one of the most common reasons people seek it out is for chronic back pain relief. Spinal cord stimulator surgery is an attractive option for people who have followed medical advice for conservative treatments and still suffer from debilitating pain. Additionally, it can help for people who are looking to avoid a more involved spine procedure or who are dealing with complications related to a previous surgery.

If you’re interested in learning more about the potential benefits of spinal cord stimulator surgery and how it can help with chronic back pain, take a moment to read this brief article. Patient education is an extremely important aspect of the treatment journey, and we’re committed to helping people make informed and confident decisions that can offer a return to an active lifestyle.

Causes of chronic back pain

Because of the enormous amount of strain and pressure that is placed on the spine, chronic back pain is a very common ailment that affects millions of people each year. While minor injuries such as muscle strains result in acute pain that improves in a short period of time, chronic back pain persists for months, years or even longer. This can negatively impact work, relationships and hobbies, leading to a downward spiral of worsening pain, declining mental health and a sedentary lifestyle.

The most common causes of chronic back pain are age-related issues like spinal arthritis and degenerative disc diseases that can lead to bulging and herniated spinal discs. These conditions can in turn cause painful nerve compression that results in symptoms such as radiating pain, muscle weakness and numbness. Another cause of chronic back pain is a condition called arachnoiditis. This is when a membrane that surrounds the spinal cord becomes inflamed, resulting in debilitating pain.

Upon diagnosing one of these or another condition as the underlying cause of chronic back pain, the standard medical advice for initial treatment is conservative, or nonsurgical, therapies.

Conservative treatments for chronic back pain

In very many cases, patients with chronic back pain are able to find lasting relief by following a course of conservative treatments and making appropriate lifestyle changes. Common recommendations include:

  • Over-the-counter medications, such as nonsteroidal anti-inflammatory drugs
  • Corticosteroid injections to reduce inflammation on a medium-term basis
  • Physical therapy to help strengthen the back and improve range of motion
  • Healthy lifestyle choices, such as quitting smoking, eating a healthy diet and getting regular exercise
  • Posture improvement to help relieve pressure on the lower back
  • Weight management programs

While these and other options help many people find relief, in other cases, chronic back pain can become severe. With physical therapy, which can be a highly effective treatment, patients with chronic pain may be unable to complete a program.

When to consider spine surgery 

If conservative treatments have been exhausted without bringing the relief necessary for a good quality of life, a doctor’s medical advice may be to explore surgical options. A spinal decompression procedure may be recommended for patients with nerve compression resulting from a herniated disc or a bone spur. For more advanced cases of spinal degeneration, surgeons can perform a fusion, or stabilization, procedure to stabilize the spinal column. Thanks to advancements in surgical technology and technique, these types of procedures can be performed with a minimally invasive approach on an outpatient basis.

However, for some patients, spine surgery may not be viable due to an inoperable condition, a medical issue or another concern.

When to consider spinal cord stimulator surgery

Since it is even less invasive than many minimally invasive spine procedures, spinal cord stimulator surgery may be advised for chronic back pain sufferers who are unable to undergo another spine procedure. The procedure can be performed on an outpatient basis in a very short period of time and the recovery period for most patients is minimal.

One feature of spinal cord stimulator surgery that is appealing for many is that it offers a trial period that lets patients determine whether it delivers sufficient pain relief before undergoing the permanent procedure. This can help offer peace of mind and more confidence in making this important treatment decision.

Spinal cord stimulator surgery trial period

During the trial procedure, the surgeon will attach the electrodes to the area around the affected spinal nerves, but instead of permanently implanting the generator, the wires will be attached to an external device. After that, the patient will spend about a week with the trial device and note the level of pain relief they experience.

If the surgeon and patient both agree that the pain relief was sufficient to warrant a permanent spinal cord stimulator, the next step will be spinal cord stimulator surgery.

Spinal cord stimulator surgery and recovery

Surgeons typically perform spinal cord stimulator surgery on an outpatient basis, with many procedures taking place in an ambulatory surgery center. Using X-ray guidance, the surgeon will permanently place the electrodes on the target area of the spinal cord and carefully tunnel wires under the skin. There are different locations where the small generator pack can be implanted, including in the lower back and the abdomen. This usually involves a very small incision and limited disruption of soft tissue.

Upon recovery, the postoperative team can give the patient instructions for incision care, safe stimulator operation and how to use the controller device. Spinal cord stimulators can be adjusted as needed and it is recommended not to use while driving or operating heavy machinery.

Patients can typically begin moving soon after the surgery and pain and soreness should be limited. It is essential to follow medical advice and the timeline for resuming activities to ensure your body heals from surgery and the implanted stimulator device is not disrupted during this time. There will typically be a follow-up appointment in the weeks following the procedure to ensure the surgical site is healing properly and that the stimulator is placed and working correctly.

Reach out to USA Spine care today

Our caring and dedicated team will be happy to help you learn more about the full range of treatment options available at our state-of-the-art centers, including spinal cord stimulator surgery. 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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