Spinal Cord Stimulator Implant (Neuromodulation) for Arachnoiditis

Arachnoiditis is a condition characterized by an acute inflammatory stage that occurs in the arachnoid (interior) and the dura (exterior) membranes. In recent years, spinal cord stimulation (SCS) has been used to successfully treat the pain associated with arachnoiditis.

What causes arachnoiditis?

The two membranes that cover and protect the brain, spinal cord, and nerve roots become inflamed with arachnoiditis. The arachnoid contains cerebrospinal fluid, which circulates from the brain to the lower spine every two hours and responds to inflammation. With scarring and fibrosis formation, abnormal adhesions form on nerve roots, which produce significant neuropathic pain.

What is a spinal cord stimulator?

A spinal cord stimulator is a small device surgically placed under the skin to send mild electrical current to the spinal cord. This involves the use of electrodes that are placed along the spinal column and wires that extend from the electrodes to the device, which is placed under the skin of the buttock or lower abdomen.

How does a spinal cord stimulator work?

A spinal cord stimulator uses low voltage electrical current to stimulate the spinal nerves, which blocks the feeling of pain. This is an option for chronic (long-term) pain, such as that associated with arachnoiditis. By interrupting pain signals, the spinal cord stimulator implant procedure shows success for returning people to a more active lifestyle. The tiny battery-powered generator transmits an electrical current to the spinal cord, which produces a tingling sensation.

Does the spinal cord stimulation eliminate the pain?

Spinal cord stimulation does not eliminate the source of pain; rather, it interferes with the pain signals to the brain. Pain relief varies from person-to-person. Most patients find the tingling sensations pleasant, and the goal of SCS is to reduce pain by at least 50%.

Who is a candidate for spinal cord stimulation, also known as neuromodulation?

Before undergoing spinal cord stimulation procedures, the doctor will evaluate and assess your condition. You are a candidate if you:

• Have had pain and disability for more than one year.
• Respond to the spinal cord stimulation trial.
• Have not had good results with other treatment modalities.
• Have a verifiable source of pain.
• Would not benefit from any additional surgery.
• Don’t have a psychiatric condition that contributes to your pain.

What is involved in a trial stimulation procedure?

Before permanent placement of a spinal cord stimulator implant, a trial of stimulation is used to see if the device will work. Effectiveness depends on the type, severity, and location of pain. The trial lead is placed into the epidural space using a hollow needle. The needle is inserted after the skin is numbed using a local anesthetic. Wires run from the trial lead to a generator, which is outside the body. If the trial reduces pain by at least 50%, it is considered to be a positive result.

What happens before SCS surgery?

You will be scheduled for presurgical tests before the spinal cord stimulator implant procedure. After the doctor reviews your medical history and test results, he goes over your medications. Certain blood thinners must be held for several days before surgery. Arrange to have someone drive you home, and do not eat or drink after 12 am the night before surgery. When you arrive at the surgery center, a nurse has you put on a procedure gown, and places an IV line in your arm.

What happens during spinal cord stimulator implant surgery?

After you are positioned on the table, a sedative or anesthesia is given. The back and abdomen areas are shaved and prepped. Local anesthesia is used to numb the skin and deeper tissues. Placement of the surgical leads is done using fluoroscopy and a small special needle device. Wires are threaded under the skin to attach to the generator. A small incision is made in the lower abdomen region so the generator can be placed under the skin. Once the device and leads are positioned, the incisions are closed using sutures.

Does spinal cord stimulation work?

According to several clinical studies, spinal cord stimulation has a 60-90% success rate for treating chronic pain.

Resources

Henderson JM, Schade CM, Sasaki J, et al: Prevention of mechanical failures in implanted spinal cord stimulation systems. Neuromodulation 2006;9(3):183-191.

North RB, Ewend MG, Lawton MT, et al: Spinal cord stimulation for chronic, intractable pain: Superiority of “multichannel” devices. Pain 1991;44:119-130.