Spinal Cord Stimulation, What and When…
When to Try Spinal Cord Stimulation After Spine Surgery
For individuals who have undergone spine surgery but continue to experience chronic pain, spinal cord stimulation (SCS) may offer relief when other treatments fail. Post-surgical back pain, also known as failed back surgery syndrome (FBSS), is a condition where pain persists or worsens after a spine procedure. In these cases, spinal cord stimulation can serve as a minimally invasive option to improve quality of life.
This article explores when it may be time to consider spinal cord stimulation after spine surgery and how it works to address chronic pain.
What Is Spinal Cord Stimulation?
Spinal cord stimulation is a pain management technique that uses a small, implantable device to deliver mild electrical impulses to the spinal cord. These impulses interfere with pain signals traveling to the brain, often replacing them with a tingling sensation called paresthesia or eliminating the pain altogether.
The SCS system consists of:
• A pulse generator, which delivers electrical impulses.
• Leads (thin wires) placed near the spinal cord.
• A remote control, allowing the patient to adjust the stimulation as needed.
When to Consider Spinal Cord Stimulation After Surgery
Spinal cord stimulation is typically considered when other treatments have failed to provide relief after spine surgery. It is not the first line of treatment but may be recommended in the following scenarios:
1. Persistent Pain Despite Surgery
• Some patients continue to experience back or leg pain even after a technically successful spine surgery. This is often referred to as failed back surgery syndrome (FBSS).
• If additional surgeries are unlikely to improve the condition, SCS may be a viable option.
2. Limited Response to Conservative Treatments
• Before considering SCS, patients usually try less invasive treatments, including physical therapy, medications, and nerve blocks. If these do not provide sufficient relief, SCS might be recommended.
3. Dependence on Pain Medications
• Chronic reliance on opioids or other pain medications can have significant side effects and risks. SCS offers a non-drug alternative for managing pain.
4. Nerve Pain Symptoms
• SCS is particularly effective for neuropathic pain, which often manifests as burning, tingling, or sharp pain in the back, legs, or arms. If the pain is primarily nerve-related, SCS may offer better results than for mechanical or structural pain.
5. Candidacy for the Trial Period
• A unique feature of SCS is the trial phase, during which temporary leads are implanted to determine if the device effectively reduces pain. If the trial provides significant relief (usually 50% or more), permanent implantation may be recommended.
Benefits of Spinal Cord Stimulation
Spinal cord stimulation offers several advantages, especially for patients struggling with post-surgical pain:
• Minimally Invasive: Implantation is less invasive than repeat spine surgery.
• Adjustable Pain Relief: Patients can control the intensity of stimulation.
• Reduced Medication Use: SCS can reduce or eliminate the need for opioids or other painkillers.
• Customizable Technology: Newer SCS devices offer options like paresthesia-free stimulation and personalized programming.
When to Delay or Avoid Spinal Cord Stimulation
SCS may not be appropriate for everyone. It might not be suitable in the following situations:
• Uncontrolled Psychological Conditions: Depression, anxiety, or other untreated mental health conditions can impact the effectiveness of SCS.
• Ongoing Structural Problems: If the pain is due to an unresolved mechanical issue, further corrective surgery may be needed.
• Infections or Medical Risks: Active infections or medical conditions that increase surgical risks can delay or rule out SCS.
The Process of Getting an SCS Implant
1. Evaluation
A pain specialist or spine surgeon assesses your medical history, imaging, and response to prior treatments.
2. Trial Period
Temporary leads are implanted to test how well SCS reduces your pain. The trial lasts 5-10 days.
3. Permanent Implantation
If the trial is successful, the pulse generator and permanent leads are surgically implanted. This is an outpatient or same-day procedure in most cases.
4. Follow-Up and Adjustments
After implantation, the device is programmed, and patients receive guidance on managing and adjusting the settings.
Conclusion
Spinal cord stimulation offers hope for individuals dealing with persistent pain after spine surgery. If you’ve tried conservative treatments without success or are hesitant to undergo another invasive procedure, SCS may provide the relief you need. The trial phase ensures that patients can test its effectiveness before committing to permanent implantation, making it a low-risk, high-reward option for managing chronic pain.
Consulting a pain specialist or spine surgeon is the first step in determining if spinal cord stimulation is right for you. With the proper evaluation and care, SCS can significantly improve your quality of life and help you regain control over your daily activities.
