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Spinal Cord Stimulator Trials

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A guide to the spinal cord stimulator trial period

Spinal cord stimulator procedures are unique in that they typically involve a trial period. The goal of this trial is to determine if spinal cord stimulation will be an effective form of treatment before the device is permanently placed. If there is a successful trial, patients can then move forward for the full procedure.

Patients looking into spinal cord stimulator procedures who want to learn more about what is involved in the trial period should take a moment to read the following practical guide. Spinal cord stimulator therapy can be a highly effective way to relieve chronic pain for a number of specific conditions and a better understanding of what makes a successful trial can help you determine if it is right for you.

Who is a potential candidate for spinal cord stimulator trials?

Spinal cord stimulation therapy works by sending a gentle electrical pulse near the spinal cord to disrupt chronic pain signals that travel from spinal nerves to the brain. Stimulators consist of a generator pack connected to two small thin wires that attach to electrodes that can be placed on tissue. In the case of spinal stimulation, surgeons will attach the electrodes to the epidural space immediately around the spinal cord.

In a permanent procedure, the generator pack is implanted discreetly in the body, usually either in the lower back or the abdomen. However, before implanting the device permanently, surgeons will typically administer a trial to see if electrical stimulation can offer relief.

Spinal cord stimulator candidates are typically chronic pain sufferers who have fully exhausted conservative treatments for their condition or illness without finding the relief necessary to perform daily activities. In many cases, patients have also previously undergone a spine surgery that resulted in complications or insufficient pain relief.

Spinal cord stimulation can help patients dealing with the following conditions:

  • Chronic pain related to a spine condition such as bulging or herniated discs
  • Failed back surgery syndrome (FBSS)
  • Arachnoiditis, which is inflammation of a spinal membrane
  • Complex regional pain syndrome
  • Diabetic neuropathy
  • Angina or other cardiovascular complications

What to expect during the trial period 

The FDA strongly recommends any patient undergo the trial period to ensure satisfactory pain relief. For the spinal cord stimulator trial procedure, the surgeon will access the target area of the spine to attach the electrodes, or leads. This can often be accomplished by injecting a very thin hollow needle and guiding it with the help of X-ray technology. During this procedure, the surgeon and patient can communicate to ensure that all pain areas are covered

The wires are then connected to an external generator that sends the electrical impulses to the spinal nerves. The patient is then given a handheld controller that is programmed based on patient feedback. The surgeon or member of the treatment team will then explain how to adjust the controller to alter the amount of electrical stimulation traveling to the spinal nerves.

The whole procedure lasts no more than one to two hours and requires minimal recovery. Patients can return home on the same day of the procedure.

How long does the trial period last?

Spinal cord stimulator trials typically last about a week, or five to seven days on average. During this time, patients can practice adjusting the controller and noting how it offers relief. The surgeon or another treatment professional will typically ask the patient to notate pain relief levels, particularly during different times of day and activities.

How do doctors and patients determine a successful trial?

After the trial period, the patient will consult with the surgeon again to determine whether or not the stimulator offered significant relief during daily activities to warrant a permanent procedure. The expectation for a successful trial is increased comfort throughout the day and night and a higher aptitude for carrying out daily activities.

What to expect during the permanent spinal cord stimulator procedure

The permanent spinal cord stimulator procedure is similar to the trial procedure in many ways. In some cases, the trial leads can remain on the spinal cord but in other situations they may need replacement depending on the specific device and procedure. The primary difference with a permanent procedure is that the surgeon will need to make a small incision to implant the generator pack as well as carefully tunnel the wires.

This procedure is still minimally invasive and can be performed on an outpatient basis. Recovery is limited compared to many other spine conditions, but it is still important to follow instructions and not resume activities too quickly to ensure the device is set properly while the body heals.

It is also common for patients to instruct family members or close friends on how to adjust or turn off the controller if the patient is unable to for any reason.

Learn more about spinal cord stimulation with USA Spine Care 

At our state-of-the-art outpatient centers, our experienced and skilled surgical team has decades of combined experience performing spinal cord stimulator trials, as well as determining whether there was a successful trial and performing permanent procedures. We’re committed to exceptional care and patient education, all with a streamlined experience that ensures everyone who comes to us for relief feels involved and confident at every step of their journey.

If you’d like to learn more about how we can help you get back to a healthy and active lifestyle, 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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