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What to Expect From Spinal Cord Stimulator Surgery


Spinal cord stimulator surgery — what to expect

Spinal cord stimulator surgery is a procedure to implant a device known as a spinal cord stimulator. Usually consisting of a small battery pack and two small electrodes that run to a spot near the spinal cord, spinal cord stimulators can be highly effective in treating chronic back pain. This type of operation is usually divided into two phases: a trial period and a followup procedure to permanently place the implanted device.

For patients whose lives are being severely disrupted by chronic back pain, a spinal cord stimulator can offer the relief necessary for a return to normal activity levels. It can also make it possible to complete treatments, such as physical therapy, that can help with long-term relief and may not have been possible otherwise.

At USA Spine Care, we’re committed to patient education. By becoming more informed about the full range of available treatment options, including spinal cord stimulator surgery, we hope you can make the best decision about your care. If you would like to learn more after reading the following guide, don’t hesitate to reach out to us.

Who is a candidate for spinal cord stimulator surgery?

Spinal cord stimulators are recommended for a wide range of conditions that cause chronic back pain, neck pain and general neuropathic symptoms. These include failed back surgery syndrome (FBSS), inflammation of tissue near the spinal cord known as arachnoiditis, neuralgia related to diabetes and other conditions and degenerative spine conditions such as bulging and herniated discs.

Patients who are candidates for spinal cord stimulator surgery have usually fully exhausted conservative treatments without finding meaningful relief. In the case of people who have previously undergone back surgery, a spinal cord stimulator can be an effective option if a followup surgery is not viable or desirable. If a surgeon deems a patient as a good potential candidate for spinal cord stimulator surgery, the first step is to undergo a trial procedure.

Spinal cord stimulator trial period

Trial periods for spinal cord stimulators are a relatively unique feature of this type of treatment. It allows the surgeon and patient to determine if spinal stimulation would be effective without fully placing the implanted device. The trial procedure involves the surgeon placing small wires near the epidural space of the spinal cord. This can be performed with a needle and X-ray guidance, which minimizes the recovery time needed for the procedure. Instead of placing an implanted device under the skin, the battery pack stays outside the body during the trial period.

Upon recovery, patients are given a controller and instructions for setting the level of electrical stimulation. The trial period will usually last for a week, after which time the patient can report the level of effectiveness back to the surgeon and which settings seemed to offer the best relief for chronic back pain.

Steps for a typical spinal cord stimulator surgery

If the trial period is a success, the next phase will be spinal cord stimulator surgery to permanently place the implanted device. This is typically performed on a minimally invasive basis, including at an outpatient ambulatory surgery center.

The procedure will typically involve the following steps:

  • A thin and hollow needle will be inserted at two separate locations to permanently implant the leads, although in some cases the trial leads are used, once again this will involve X-ray guidance
  • The surgeon will make a small incision at the location where the power pack will be inserted, which will vary from patient to patient, with common locations being the lower back or in the abdomen
  • The surgeon will carefully tunnel wires from the implanted device to the leads near the spinal cord
  • The incision will be closed and the patient will begin the recovery process

Once the patient has been fully awakened, they will be moved to the recovery area and given instructions for resuming activity and using their spinal cord stimulator. Patients are typically up and moving within a couple of hours and are able to return home the same day of the procedure.  Like other procedures, the recovery period for spinal cord stimulator surgery is extremely important and patients should follow all postoperative care instructions to ensure a successful outcome.

Recovery period and caring for the implanted device

Although spinal cord stimulator surgery is minimally invasive, patients should still expect to experience a small degree of pain at the surgical site in the weeks following the procedure. It is important to follow all recovery guidelines and not resume activities until instructed to avoid disrupting healing tissue or moving the device.

Patients should also follow any instructions for operating and maintaining their individual device. As there are a wide range of spinal cord stimulators, always consult with your surgical provider about correct usage for your device. Some common recommendations are to avoid having the device operating while driving and to instruct family members and other people on how to turn off the implanted device in case the person cannot reach it for any reason.

Learn more about spinal cord stimulator surgery at USA Spine Care

USA Spine Care has a team of highly skilled and experienced surgeons who can perform spinal cord stimulator surgery at our state-of-the-art outpatient facilities. Our mission is to help patients find the type of treatment that fits their condition, lifestyle needs and treatment goals. To learn more about becoming a candidate for spinal cord stimulator surgery, contact us today. We’re proud to work with most major insurance providers, Medicare, workers’ compensation claims and personal injury cases and we’ll be happy to answer your questions about spinal cord stimulator surgery cost.

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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