Boston Scientific Spinal Cord Stimulator Patient Information
What is spinal cord stimulation?
Spinal Cord Stimulation (SCS) alters the experience of pain by sending impulses to the spinal cord that compete with pain signals. As a result, the pain messages that your body sends to the brain are blocked or modified.
What is a spinal cord stimulator?
A spinal cord stimulator system is made of four parts:
- Impulse Generator (IPG): this is a computer that is roughly the size of a matchbox that controls the impulses delivered to the spinal cord. It is implanted under the skin and has an inbuilt battery.
- An electrode: this sits in the epidural space and delivers very small and precise currents to the spinal cord.
- A hand-held controller: this is used to turn the system on and off, adjust the type of stimulation, location of stimulation and level of stimulation.
- A hand-held charger: some IPGs are rechargeable and require regular charging to maintain stimulation.
What conditions can SCS treat?
Spinal cord stimulation is most commonly used for leg, back and arm pain that has not responded to spinal surgery. It can also be used to treat back pain that is not suitable for spinal surgery. Other conditions that may also respond to SCS include complex regional pain syndrome (CRPS), pain following nerve injury, refractory gain, post-herpetic neuralgia and peripheral vascular disease.
If your pain specialist decides that this treatment is suitable for your condition, a comprehensive trial is undertaken to determine if SCS will be helpful to you. There are many different spinal cord stimulator devices available for the management of chronic pain. Your pain specialist will determine the appropriate spinal cord stimulator for you, by assessing you independently and using up-to-date clinical research and current best practice.
What is involved in a trial?
An SCS trial is performed at the Interventional Procedure Centre within North Shore Private Hospital (located within Royal North Shore Hospital) in an operating theatre equipped with specialised x-ray equipment. You will be given intravenous sedation by an anaesthetist to help you relax throughout the procedure.
After administering local anaesthetic, a specialised needle is used to enter the epidural space which lies underneath the bones of the vertebrae. A thin stimulator lead (electrode) is then advanced in the epidural space to a specific level of the spine. When the stimulator is positioned correctly, it will be secured to the skin and covered with a dressing. This will remain in place for the duration of the trial.
Throughout the trial period different modes of stimulation may be used to confirm the effectiveness of this treatment in your specific case. You will usually be discharged home the day following insertion of the trial lead, but will require follow up with your pain specialist at Northern Pain centre throughout the trial periods of 7-10 days.
Throughout the trial period it is important that you follow the restrictions given to you by the device representative, Northern Pain centre nursing staff and your pain specialist. It is also important that you complete the pain diary to determine the effectiveness of the SCS over the course of the trial period.
At the completion of the trial, the lead will be removed, and a decision will be made whether to proceed to permanent implant.
How is a permanent implant performed?
SCS implants are performed at North Shore Private Hospital in an operating theatre. You will be admitted on the day of the procedure. An anaesthetist will be present to give you sedation. The stimulator leads (electrodes) are again inserted via a specialised needle. Once correct positioning is confirmed the leads are secured under the skin.
A small impulse generator/battery (IPG) is then implanted under the skin at a site chosen by you and your doctor. You will usually remain in hospital for one to two nights before being discharged home.
A technician from the SCS device company will work with your doctor to program the stimulator to give you as much relief as possible.
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What happens after the implant?
It takes some weeks for the electrodes to self become fixed to your body’s tissues. During this time you should avoid extreme activities but after this time you will be encourages to gradually increase your activity levels under supervision by our specialised physiotherapists.
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Some body scanners and medical imaging can interfere with the spinal cord stimulator. In general, any sign that gives warnings for people with heart pacemakers also applies to spinal cord stimulators. Ask your specialist for more information.
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