frequent procedures
 

SPINAL CORD STIMULATOR
The spinal cord stimulator, previously described as a dorsal column stimulator, is a device that operates through the Gate Control Theory and involves placement of different designs of leads over the dorsal column of the spinal cord, usually at the thoracic or cervical level, to control pain in the lower extremities or upper extremities respectfully. This pain could be pain originating from complex region pain syndromes/RSD or pain originating from post-laminectomy syndrome and epidural fibrosis and radicular pain to the lower extremity or pain from inoperable nerve root irritation or compression that results in lumbar radiculopathy or upper extremity radiculopathy as well as low back pain and neck area pain respectively. There are many other indications.

The approved indication for this procedure is varied but the actual treatment itself involves low-current stimulation electrode leads overlying the area of the dorsal horn of the spinal cord at the appropriate level through a selective adjustment and testing process in the vicinity of the predicted level to achieve the optimal location as well as the intensity of the current, the quality of the current, and the frequency of the current in order to achieve proximal outcome in the therapy. The goal is to replace the radicular pain in the lower extremity with a new sensation that overrides the pain signals carried up the spinal cord in these patients or to alter the autonomic nervous system mediated pain of complex regional pain syndrome where the wind-up phenomenon has already occurred in the dorsal horn of the spinal cord. This procedure is usually done under fluoroscopic guidance with light sedation and different stages will require patient awareness to be able to evaluate appropriate placement and optimal outcome. In a test situation, the patient is allowed to wear this device for a few days and to return to be evaluated with the pain diary that the patient keeps as regards the outcome of this trial. With suitable reduction of the patient's pain medication requirements or evaluation of the patient's pain from this testing process, the patient may receive a permanent implant of the spinal cord stimulator as well as the pulse generator.

In place of the pulse generator, the patient may also receive a pulse receiver with the actual generator being superimposed at above the skin of the patient's as an external device to be worn by the patient under his or her clothes. The choice is that of the patient's as well as the number of leads that are being utilized in the patient's treatment since in an extensive area of stimulation, more current is dissipated in the patient's dorsal horn region and it will be preferable to use an external power generator device since an implanted pulse generator is likely to have its battery run down early, resulting in frequent surgical procedures and increased risk of infections within that vicinity. Different companies, including ANS as well as Medtronic, have specialized in different devices and have extensive experience in this method of treatment of chronic pain.

CONTRAINDICATIONS: Contraindications include patient's that are prone to infection including immunocompromised patients. This may include patient's who have chronic diabetes, patient's on chronic dialysis as well as patient's with HIV/AIDS to name a few. Patients on anticoagulation are also related contraindication. Patient's who are very thin and who have cachexia and no fat/muscle tissue to allow implantation of either the pulse generator or the pulse receiver are also relative contraindication.

COMPLICATIONS: Complications include infection of the site of the placement of the pulse generator and migration of the electrodes and leads that are implanted. The patient also may have breakage of the leads during attempts to remove the leads from the dorsal horn of the spinal cord, though this is infrequent.

SEDATION: The procedure is done under monitored anesthesia care with light sedation and the patient is usually allowed a period in which testing can be done to confirm adequate placement of the neural electrodes with leads on the dorsal area of the spinal cord.

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