SPINAL CORD STIMULATION SPECIALIST

What is spinal cord stimulation?

Spinal cord stimulation is a treatment for pain that uses tailored electrical fields to block nerves from conveying pain impulses up the spinal cord to the brain. Spinal cord stimulation, also called neurostimulation, achieves this by placing small wires with electrodes in the epidural space. The exact position of these electrodes combined with the appropriate type of electric field is key to success. The wires are connected to a small, “pacemaker-like” device called an IPG that is implanted either in the flank or buttock and has a rechargeable battery charged from the external surface of the skin. The IPG is also infinitely reprogrammable via a wireless interface, so that the settings can be constantly adjusted to keep up with changes in the pattern of the patient’s pain.

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Spinal Cord Stimulation

Stimulation does not eliminate the source of pain, it simply interferes with the pain signals going to the brain. There are many different settings that can be programmed into the IPG. Some of these programs are not felt by the patient, while others can cause a tingling sensation called paresthesia. The amount of pain relief varies for each person and some patients may find the paresthesia to be annoying or even unpleasant. For this reason, a stimulation trial is always performed before the device is permanently implanted. Trial leads are usually temporary and brought out to the skin where they are taped in place. Trials usually last 1-2 weeks after which the leads are simply pulled out. The gold standard for implanting a spinal cord stimulator is a 50% reduction in pain during the trial.

How does spinal cord stimulation work?

The spinal cord ends at the L1 vertebral body level and is located inside of the membrane that contains the spinal fluid (the dura). Most spinal cord stimulator leads are inserted below L1 and threaded up the space in the spine that is outside of the dura (the epidural space). This means that it is a very safe procedure and very unlikely to damage underlying nerves and / or the spinal cord. Sometimes patients develop a resistance to the stimulation over time (much like with medication). If this occurs the implant can be easily removed without damaging the structures of the spine.

Newer spinal cord stimulators are being designed to be able to absorb the energy of an MRI and are therefore considered “MRI compatible.” These newer stimulators can only handle lower energy MRI scanners that are 1.5 Tesla or less in magnetic field strength. As the technology improves these devices are becoming safer and more effective at containing the pain impulses in the spinal cord.

Who are the candidates for spinal cord stimulation?

Not everyone with chronic pain is a candidate for spinal cord stimulation therapy. Candidates for spinal cord stimulation generally have chronic pain in their arms, legs or back that has lasted for six months or longer. Their pain is “neuropathic,” meaning that it produces a burning, tingling, or numb sensation; and they have not found adequate relief with other treatment options.