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Spinal Cord Stimulator Trial / Implants

Neurostimulation

Pain Treatment Centers of America offers a variety of minimally invasive pain treatment procedures that we have perfected to help you achieve pain relief. Our treatments have been proven effective and are on the cutting edge of science related to pain reduction. Our goal is to improve every patient’s overall function and thus restore a better quality of life.

Overview:

Spinal cord stimulation is a minimally invasive procedure used to treat chronic pain that has failed to respond to more conventional treatments – rest, physical therapy, over the counter medications, prescription medications and injection therapy. The process involves using low voltage stimulation of the spinal nerves to block the feeling of pain. It helps you to better manage your pain and potentially decrease the amount of pain medication typically needed as well as improve functionality. It may be an option if you have long-term (chronic) leg, foot, arm, hand, back or other pains and have not found relief through traditional methods. A small battery-powered generator implanted in the body transmits an electrical current to your spinal cord. The result is a pleasant “tingling sensation” instead of pain. By interrupting pain signals, the procedure has shown success in returning many people to a more active lifestyle.

Conditions commonly treated spinal cord stimulation:

  1. Failed back surgery syndrome – continued pain despite surgery to the spine
  2. Radiculopathy – pain that progresses down your arms/hands or legs/feet
  3. Complex Regional Pain Syndrome – a progressive sympathetic nerve mediated process resulting in chronic pain typically in the arm/hand or leg/feet. This pain is described as burning/tingling and can be associated with skin, hair and nail changes
  4. Arachnoiditis – painful inflammation and scarring of the meninges (nerve protective wrappings)
  5. Neuritis/Neuropathy
  6. Other chronic pain – stump pain, multiple sclerosis, spinal cord injury, peripheral vascular disease

The procedure:

(please refer to our Pre-procedure Instructions for specifics)

Spinal Cord Stimulator Trial (the test drive Video #1 Above) – The trial is very important part of the process as it will allow us to see if spinal cord stimulation will work for your pain.
Please arrive 20 minutes prior to your appointment on procedure day. Our nurses will start an IV if you are requesting sedation and take a pre-operative nurse assessment. All patients are taken to the procedure room on a hospital bed. Once in the procedure room you will be given sedation to help make you comfortable. A cold cleaning solution will be placed on your skin to help decrease chances of infection. The procedure site is then identified by your doctor under x-ray guidance. Once the site is identified a shot of numbing medicine (typically bupivicaine) will be given. This may feel like a bee sting, but will only last a few seconds. An epidural needle is then placed into the epidural space using x-ray guidance. Once proper needle placement is confirmed a small electrode (specialized wire) will be inserted through the needle into the epidural space. This procedure is then repeated as most trials require the placement of two electrodes. Once the electrodes are placed a representative from the device company will turn on the spinal cord stimulator and you will be asked to describe what you feel. The representative will then work to replace your typical pain with the “pleasant tingling sensation.” This is not painful and typically takes anywhere from 5-10 minutes. The needles will then be removed and the electrodes secured to your back with tape and a few stitches. The pulse generator (battery) will be connected to the electrodes and simply taped to your back. You will be instructed on proper care prior to leaving the facility. The trial lasts for 5 days and then you will return to clinic. It is important to actually “test drive” the device – do your daily activities and see how it affects your overall pain. Please continue all pain medications exactly as prescribed. When you return to clinic we simply remove the electrodes and place a small bandaid over the lower back. If you feel at least a 50% decrease in your normal pain as well as an improvement in function, then the trial is considered successful and you have the option to proceed to permanent placement.

Spinal Cord Stimulator Permanent Implantation – done ONLY after successful trial

If you are receiving your permanent spinal cord stimulator through an outside surgeon please refer to their very specific instructions as these can vary by physician.

Permanent implantation is a surgical procedure and is typically done only in an operating room setting. This procedure can be divided into two categories – a laminotomy (done by outside surgeon) and a percutaneous implant (typically done by your pain management physician).

Laminotomy – (please refer to specific surgeon instructions as this can vary by physician) a laminotomy is typically performed by either an orthopaedic surgeon (bone surgeon) or by a neurosurgeon (spine and brain surgeon). This procedure is done in a hospital or ambulatory surgery setting and requires general anesthesia (being put to sleep). A small incision is made in the lower back for placement of the electrodes as described in the trial. The electrodes are secured to the ligaments and bone of the spine. Laminotomy refers to the removal of a small amount of spinal bone for proper electrode placement. Once the electrodes are placed they are sewn into place. The pulse generator (battery) is then placed beneath the skin over the buttocks region. Your surgeon will then tunnel the electrodes under the skin and connect these with the pulse generator. All skin incisions are then closed and patient will be transferred to the recovery room.

Percutaneous Implant – The percutaneous implant is done by your pain physician. Please arrive 20 minutes prior to your appointment on procedure day. Our nurses will start an IV if you are requesting sedation and take a pre-operative nurse assessment. All patients are taken to the procedure room on a hospital bed. Once in the procedure room you will be given sedation and nitrous oxide gas (laughing gas) to help make you comfortable. A cold cleaning solution will be placed on your skin to help decrease chances of infection. The procedure site is then identified by your doctor under x-ray guidance. Once the site is identified a shot of numbing medicine (typically bupivicaine) will be given. This may feel like a bee sting, but will only last a few seconds. An epidural needle is then placed into the epidural space using x-ray guidance. Once proper needle placement is confirmed a small electrode will be inserted through the needle into the epidural space. This procedure is then repeated as most trials require the placement of two electrodes. Once the electrodes are placed a representative from the device company will turn on the spinal cord stimulator and you will be asked to describe what you feel. The representative will then work to replace your typical pain with the “pleasant tingling sensation.” This is not painful and typically takes anywhere from 5-10 minutes. A small skin incision is then made over your lower back to attach the electrodes beneath the skin. The pulse generator is then placed over the buttocks regions just beneath the skin. Your physician will then tunnel the electrodes beneath the skin and attach them to the pulse generator. All skin incisions are closed and you will be transported to the recovery room.

What to expect after procedure:

Discomfort – the surgical procedure itself may cause some pain. Continue taking your pain medications as prescribed. You may use ice packs and over the counter pain relief medications for the short term pain.

Follow up visit – Return to clinic around 10 days after your surgery for removal of the staples and stitches. You may need to contact the company representative to adjust your spinal cord stimulator and help you create programs to cover your pain.

Restrictions:

  1. Avoid the following activities for 6-8 weeks to prevent electrode movement:
    Avoid any bending, twisting, stretching or lifting above your head of anything over 5 pounds
  2. Do not raise your arms above your head
  3. Do not sleep on your stomach
  4. No sexual activity until your first follow up appointment

Bathing/Incision Care:

  • You may shower, but do not submerge yourself in a bath or water until after your first follow up visit.
  • Steri-strips or bandaids may be placed around incision and will gradually fall of by themselves. Any staples or stitches should be left in place until your first follow up visit.
  • Inspect the incision twice daily and make sure to keep it clean and clear.

When to call your doctor:

  1. Fever over 101 degrees that lasts more than 12 hours
  2. Any sign of infection, separation or large amounts of fluid accumulation around incision site
  3. If you see any type of metal or wiring other than the stitches or staples
  4. If you suddenly develop severe lower back pain, leg paralysis, leg numbness or loss of bowel/bladder control – go to your ER or physician office IMMEDIATELY

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