SPINAL CORD STIMULATOR TRIALS AND IMPLANTS
Spinal cord stimulator (dorsal column stimulator) is a medical device surgically placed under the patient’s skin with an lead (special electrical wire) placed in the epidural space at an appropriate level to send mild electric current to the spinal cord to produce a feeling of tingling in the area over the typical everyday pain. The pain reduction is achieved due to the suppressing of the pain signal as the main pain generator the pathologic structure. It was found that the signal of the tingling sensation is much stronger compared to the signal of the pain and able to compete with the pain signal or even suppress it completely.
This particular treatment modality is offered only to the patients that failed conservative treatment, interventional procedures, and not a surgical candidates at that point. Patients need also to have psychological or neuropsychological evaluation to make sure that they are capable to use/operate the device and its remote control.
The procedure starts with the trial first. The spinal cord stimulator lead is placed into the epidural space at the appropriate level and the effect of the stimulation is checked by external device by the representative from the company producing the spinal cord stimulator generator kit. Upon the appropriate placement and testing of the leads in the epidural space, the generator is temporarily placed externally. The position of the leads are secured with sutures and the generator with special dressing. The patient is sent home with a remote control to see if the spinal cord stimulator provides sufficient pain relief for the patient. There are different modalities over the stimulation available and to be discussed with the physician and company representative during the appointment. The company representative provides the patient with education and discuss in detail with the patient how to operate the remote control and recharge the device as needed. The patient comes back to the clinic 5 days later to discuss the effect of the spinal cord stimulator trial and assess the patient for possible side effects or complications. The external generator with the lead is removed. Patient will be scheduled to have surgical placement of the leads of the spinal cord stimulator into the epidural space connected to the permanent generator placed under the skin in the low back area if the trial is successful. Patient will be provided with the further education regarding the remote control operation, maintenance and recharging the system on their own. This spinal cord stimulator system will be frequently checked by the physician and the company representative to ensure the appropriate functioning and maintenance.
