SPINAL CORD STIMULATION
If your trial screening has been successful you may elect to have a permanent spinal cord stimulation system implanted. You will return to the operating room and have a new electrode placed into your epidural space around your spinal cord. The power source will be implanted under your skin. This system will also produce tingling sensations to cover your pain sensation. The procedure in the operating room will be the same as before except your electrode, receiver and possibly the power source will be tunneled under your skin
You will control your stimulator with a hand-held programmer. You will need to learn to use your system before leaving the hospital. We will help you during your learning process. When you get home, you will need to make changes to accommodate different activities and body positions. The implanted power source has a battery life of three to five years, minor surgery is required to change it. The external power source uses 9-volt batteries and can be changed as needed.
You must attend all regularly scheduled visits with your physician. Avoid certain medical procedures such as MRI, diathermy, ultrasound, radiation therapy and chiropractic services. Consult your physician prior to any of these procedures. You should limit your activities for 6-8 weeks following implant to reduce electrode movement. This is for your benefit and long-term satisfaction with your system. Movement of your electrode can lead to loss of stimulation.
POST-SURGICAL RESTRICTIONS
SCS Implantation
Immediately after your procedure:
Stay in bed as much as possible for 10-12 hours. This will decrease possibility of electrode movement. Raise the head of your bed about 20 degrees to stabilize your spine for the first postoperative night. The next day walk for brief periods, keeping your back as straight as possible. Sleep on a firm mattress and support your legs.
For 6-8 weeks:
DO NOT:
… Put your arms over your head.
… Bend, twist, stretch or lift more than five pounds.
… Sleep on your stomach.
… Climb too many stairs.
… Sit too long in a chair, vary your positions.
… Drive for several weeks to reduce the risk of abrupt movements.
… Operate motor vehicles, power tools or equipment while your stimulator is on. Turn the stimulator off to reduce safety risks associated with sudden sensation changes.
To promote healing of your surgical wounds, avoid wetting the sites until your stitches have been removed. Sponge baths are recommended. You may feel more comfortable with the area covered by a small dressing until your stitches are removed. Call your physician if you develop any fever, chills, pus or redness.
Always carry
your patient ID card with you. This will identify your implanted device to
airport or business owners in case your system sets off security alarms. You
should also purchase a MEDIC ALERT bracelet to identify yourself as having an
implanted device in case of an emergency.
Frequently Asked Questions
What is a Dorsal Column Stimulator?
A Dorsal Column, or Spinal Cord, Stimulator is a specialized, computerized,
electronic device, which stimulates nerves by tiny electrical impulses via
small electrical wires placed on the spinal cord. It is an implantable device
designed to withstand the hostile environment of the human body. It works by
creating an electrical field around the posterior aspect of the spinal cord
(the area of the spine that manages ěsensationî). In turn, this electrical
field ěscramblesî the ěpain impulsesî so that by the time they reach the
cerebral cortex, they are interpreted as a ěsoothing, tingling sensationî.
Am I a candidate for Dorsal Column Stimulator?
Dorsal Column Stimulator is offered to patients with chronic and severe
neuropathic pain, who have not responded to other treatment modalities.
Neuropathic pain being pain due to damaged nerve tissue.
Note:
Before
proceeding with the actual implant, a series of steps will have to be taken.
You will need to be evaluated by a Medical Psychologist with experience in chronic
pain management. Assuming that your psychological profile does not
contraindicate the implant therapy, you will then have to undergo a "Spinal
Cord Stimulator trial". This trial is design to find
out if you have any problems with the device, and how effective it will be in
controlling your symptoms.
What is the purpose of it?
This device interrupts nerve conduction (such as conduction of pain signals) to
brain. The idea is to substitute the pain sensation for a soothing, tingling
sensation. The purpose is to allow the patient to perceive less pain and
therefore, be more comfortable and productive.
How long does the procedure take?
It is done in two stages. In the first stage, temporary wires are placed and an
external device is used by the patients to generate electrical current. If this
trial is successful in relieving pain, then the permanent device is placed
under the skin. Each procedure can take up to 3 hours. Success during the trial
is considered to be relief of better than 50% of the pain.
How is it actually performed?
The wires are placed under x-ray guidance and a local anesthetic like Novocain
is used to numb the skin and deeper tissues. The procedure is performed in the
operating room to maintain sterility.
Will the procedure hurt?
The procedure
involves inserting a needle through skin and deeper tissues (like a
"tetanus shot"). So, there is some discomfort involved. However, we numb
the skin and deeper tissues with a local anesthetic using a very thin needle
prior to inserting the needle. Most of the patients also receive intravenous
sedation, which makes the procedure easy to tolerate.
Will I be "put out" for this procedure?
No, you will not be ěput to sleepî, the procedure is
not done under general anesthesia. The placement of the wires is done under
local anesthesia with patients mildly sedated. This is necessary to ensure
proper placement of the wires. The amount of sedation given generally depends
upon the patient tolerance. For the generator placement, patients are given
stronger intravenous sedation.
How is the procedure performed?
It is done with the patient lying on the stomach when placing the wires. The
patients are monitored with EKG, blood pressure cuff and blood
oxygen-monitoring device. The skin is cleaned with antiseptic solution and then
the procedure is carried out. X-ray (fluoroscopy) is used to guide the needle
for wire placement.
Where are the wires inserted? Where is the generator
placed?
For the pain involving the low back and lower extremities, the wires are
inserted in the midline at the lower back. The generator is then placed on the
upper buttock area. For the pain involving upper extremities, the wires are
inserted in the midline at the upper back. The generator is then placed on the
side of the chest, or the area of the buttocks.
What should I expect after the procedure?
If the procedure is successful, you may feel that your pain may be gone or quite
less. You will experience a fairly constant sensation of stimulation. You may
have soreness due to the needles used for a day or two.
What should I do after the procedure?
This procedure is normally a day-procedure. Some patients may be kept overnight
for observation. You should have a ride home. We advise the patients to take it
easy for a day or so after the procedure. Perform the activities as tolerated
by you.
How long will the generators last?
Depending upon how much the device is used (intensity and duration), the batteries in the generator may last several years (5-8
yrs).
Will the Dorsal Column Spinal Cord Stimulator help
me?
It is very difficult to predict if the procedure will indeed help you or not.
For that reason temporary wires are placed to determine if this device will be
effective to relieve your pain or not. Typically, patients will have a 50 to 70
% reduction in their pain.
Where can I get additional information?
More detailed information is available from the manufacturer of this device. At
the time of consultation you will receive a Spinal Cord Stimulation Patient
Education Booklet. Additional information is also available at the Medtronicsô Web Site
What are the risks, side effects, and possible
complications?
Generally speaking, most procedures are safe. However, with any procedure there
are risks, side effects, and the possibility of complications. The risks and
complications are dependent upon the site of the procedure performed. The
closer to the spine, the more serious the risks are. Great care is taken to
prevent possible problems. Nevertheless, complications can still occur. The
following is not meant to be interpreted as a list of all possible problems.
Remember that unforeseen complications can occur.
1. Infection: Any time the skin is surgically
manipulated there is a risk of infection. Sterile technique and antibiotics are
used in an attempt to prevent infections. There are five possible types of
infection:
a. Localized skin infection.
b. Central Nervous System infection ń
this can be in the form of meningitis, which can be deadly.
c.
Epidural
Infections ń this can be in the form of an epidural abscess, which can cause
pressure inside of the spine, causing compression of the spinal cord with
subsequent paralysis. This would require an emergency surgery to decompress,
and there are no guarantees that the patient would recover from the paralysis.
d. Discitis ń this is an infection of
the intervertebral discs. It occurs in about 1% of discography procedures. It
is difficult to treat and it may lead to surgery.
e. Osteomyelitis ń this is a bone infection, very
rare, but also very difficult to treat due to poor blood flow to the bones.
This may also require surgery to treat.
Note:
In the case of implants, infections may require the removal of the implant.
2. Pain: All surgeries are expected to have a
postoperative recovery period where you may hurt more than usual, until the
affected tissue heals and recovers.
3. Damage to
internal structures:
Nerves and blood vessels can potentially be damaged. Please discuss your
specific concerns with your physician.
4. Bleeding: Bleeding is more common if the
patient is taking blood thinners such as aspirin, Coumadin, Ticlid,
Plavix, etc., or if he/she have some genetic predisposition such as hemophilia.
Bleeding into the spinal canal can cause compression of the spinal cord with
subsequent paralysis. This would require an emergency surgery to decompress and
there are no guarantees that the patient would recover from the paralysis.
5. Pneumothorax: Puncturing of a lung is a
possibility, every time there is work done in the area of the chest or upper
back.
6. Spinal
headaches: They may
occur with any procedures in the area of the spine.
7. Spinal fluid
leaks: This may
cause a persistent headache or accumulation of fluid in the pocket site. It may
require surgery to correct.
8. Nerve
damage: By working so
close to the spinal cord, there is always a possibility of nerve damage which
could be as serious as a permanent spinal cord injury with paralysis.
9. Death: Although rare, severe deadly
allergic reactions known as ěAnaphylactic Reactionî can occur to any of the
medications used.
10. Worsening of
the symptoms: We can
always make things worse.
11. Seromas: This is an accumulation of fluid at
the surgical site, most commonly seen at the ěpocket siteî of the implant. It
can last several weeks to months, and it may need to be drained several times,
until it stops recurring. It also has the potential of getting infected,
requiring removal of the Implant.
What are the chances of something like this happening?
Chances
of any of this occurring are extremely low. By statistics, you have more of a
chance of getting killed in a motor vehicle accident, while driving to the
Hospital, than any of the above occurring. Nevertheless, you should be aware
that they are possibilities.
Who should not have this procedure?
If you are on a blood thinning medication (e.g. CoumadinĆ,
PlavixĆ, see back), or if you have an active infection going on, you
should not have the procedure. If you are taking any blood thinners, please
inform your physician.
How should I prepare for this procedure?
…
Do
not eat or drink anything, at least six hours prior to the procedure.
…
Bring
a driver with you. Cannot be a Taxi.
…
Take
all of your medicines the morning of the procedure, with just enough water to
swallow them. If you have diabetes, do not take your Insulin or your sugar
pills (oral hypoglycemics) until after the procedure.
…
Do
not take aspirin or any aspirin-containing medications, at least eleven (11)
days prior to the procedure. They may prolong bleeding.
…
Do
not take any non-steroidal anti-inflammatory drugs, at least one day prior to
the procedure. They may prolong bleeding.
…
Wear
loose fitting clothing that may be easy to take off and that you would not mind
if it got stained with Betadine or blood.
…
Take
a shower the morning of the procedure, using a bactericidal soap to minimize
chances of infection.
…
Do
not wear any jewelry or perfumes.