How Is A Spinal Cord Stimulator For Back Pain Placed?
Low Back Pain is a major source of disability and loss of work time in the US.
If a patient fails back surgery or is having substantial low back and/or leg pain and is not a candidate for spine surgery, one viable treatment option may be a spinal cord stimulator.
A spinal cord stimulator does not fix the pain generator problem.
It can simply mask the pain.
If the problem causing the pain cannot be fixed, why not at least cover it up? This may allow patients to return to work, play with their kids, hang out with their spouse, basically just make life better.
If a spinal cord stimulator trial relieves substantial back/leg pain and the decision is made to proceed with a final implant, here is how that works.
By and large, a final spinal cord stimulator placement is performed with the patient completely out.
Usually that means general anesthesia.
The surgery involves an incision with dissection going down to the area surrounding the spine and is significantly more invasive than the placement of the trial catheter.
The trial catheter is done under IV sedation.
Once the dissection is down to the area around the spine, the physician removes a piece of the bone called the lamina.
This is called a laminectomy or a laminotomy depending on the technique.
Basically, it allows the physician to place the catheter around the spinal cord and feed it up to the same placement as where the trial catheter was placed and was achieving a satisfactory result.
The final SCS implant has a catheter with a larger tip than the trial one which resembles a "paddle.
" It's made of silicone, is flexible, and has numerous diodes on it which carry the electrical stimulation.
Once placed satisfactorily, the catheter is sutured into place to try and prevent it from migrating.
Even with proper placement and the suturing, migration happens.
The catheter is then fed subcutaneously underneath the skin to a battery supply.
The battery used are about the size of hockey puck but skinnier usually.
The battery is placed typically above the buttock area in a region under the skin where the patient will not be sitting on it.
The main complications seen are lead migration, infection, skin breakdown around the battery, and the main one is that sometimes the pain relief achieved by the trial catheter simply doesn't materialize with the final implant.
Overall success with SCS implants is 62%.
If a patient fails back surgery or is having substantial low back and/or leg pain and is not a candidate for spine surgery, one viable treatment option may be a spinal cord stimulator.
A spinal cord stimulator does not fix the pain generator problem.
It can simply mask the pain.
If the problem causing the pain cannot be fixed, why not at least cover it up? This may allow patients to return to work, play with their kids, hang out with their spouse, basically just make life better.
If a spinal cord stimulator trial relieves substantial back/leg pain and the decision is made to proceed with a final implant, here is how that works.
By and large, a final spinal cord stimulator placement is performed with the patient completely out.
Usually that means general anesthesia.
The surgery involves an incision with dissection going down to the area surrounding the spine and is significantly more invasive than the placement of the trial catheter.
The trial catheter is done under IV sedation.
Once the dissection is down to the area around the spine, the physician removes a piece of the bone called the lamina.
This is called a laminectomy or a laminotomy depending on the technique.
Basically, it allows the physician to place the catheter around the spinal cord and feed it up to the same placement as where the trial catheter was placed and was achieving a satisfactory result.
The final SCS implant has a catheter with a larger tip than the trial one which resembles a "paddle.
" It's made of silicone, is flexible, and has numerous diodes on it which carry the electrical stimulation.
Once placed satisfactorily, the catheter is sutured into place to try and prevent it from migrating.
Even with proper placement and the suturing, migration happens.
The catheter is then fed subcutaneously underneath the skin to a battery supply.
The battery used are about the size of hockey puck but skinnier usually.
The battery is placed typically above the buttock area in a region under the skin where the patient will not be sitting on it.
The main complications seen are lead migration, infection, skin breakdown around the battery, and the main one is that sometimes the pain relief achieved by the trial catheter simply doesn't materialize with the final implant.
Overall success with SCS implants is 62%.