Spinal Cord Stimulator Implant for Diabetic and Peripheral Neuropathy

Neuropathies are a family of nerve disorders that can be caused by diabetes mellitus (DM) and other diseases. People with diabetes can develop nerve damage over time, which causes pain, numbness, and/or tingling of the hands, arms, feet, and/or legs. Diabetic or peripheral neuropathy can also affect the nerves that supply the digestive tract and sex organs.

Spinal cord stimulation (SCS) is an effective treatment for the pain associated with neuropathy. The spinal cord stimulator implant is placed in the body, and it delivers electric current to the spinal cord. These impulses interfere with pain signal transmission.

How many people develop neuropathy?

Around 65% of people with diabetes have some form of peripheral neuropathy. The risk of neuropathy rises with age and longer duration of DM. People who have had diabetes for more than 25 years are at the greatest risk.

What causes neuropathy?

The cause of neuropathy is related to the type of disease. With diabetic neuropathy, prolonged exposure to high blood glucose leads to nerve damage. This is thought to be related to inflammation of the nerves, and damage to the blood vessels that carry oxygen to the extremity nerves.

What is a spinal cord stimulator?

Also called a dorsal column stimulator, the spinal cord stimulator is surgically positioned under the skin. This unit sends a mild electric current to the spinal cord, and wires run from the generator to the leads placed along the spine. The actual generator is battery-operated, and it has wires that connect from the generator to the leads.

How does the spinal cord stimulator implant work?

Neurostimulation does not eliminate the actual source of pain; rather, it interferes with the pain signal transmission from the site of pain to the brain. The amount of pain relief varies from person-to-person.

How often is the battery changed?

The pulse generator has a small battery that delivers low voltage. This must be surgically replaced every 2-5 years. However, new rechargeable battery systems can last for up to 10 years before they need to be replaced.

Who could benefit from a spinal cord stimulator implant?

Neuropathic (nerve) pain is different for everyone. Most patients with neuropathy will respond to spinal cord stimulation. Candidates for this procedure include anyone who:

• Has pain that last for more than 1 year.
• Has failed on conservative therapies.
• Has an identified source of pain.
• Is not seriously depending on pain medications.
• Does not have any psychiatric conditions.

What is a trial stimulation?

Before the permanent SCS device is implanted, the doctor will recommend a trial stimulation. This involves a simple outpatient procedure. The leads are placed into the epidural space using real-time x-ray. Wires run from these leads to a device that is outside the body. The unit delivers electrical current, and the patient wears the trial stimulator for around one week. If greater than 50% reduction in pain is achieved, the patient can have a permanent implantable device.

What happens before the surgery?

Before your surgery, you are scheduled for some tests, and a full examination is done. The doctor will discuss the procedure pros and cons, and have you sign a consent form. Be sure to discuss all medications with your doctor along with your medical history. Certain blood thinners are held for 5-7 days before the procedure. Do not eat or drink after midnight the night before your surgery, and have someone ready to drive you home.

What happens during surgery?

The doctor will administer general anesthesia, so you will not feel any pain. The surgical leads are placed along the spinal column through a small incision made in the middle of your back. You will be awakened so the doctor can perform a test stimulation. After choosing the right settings, you will be put back to sleep. An extension wire is passed from the spine around to the lower abdomen or buttock where the tiny generator is placed. Both incisions are closed with sutures.

Is spinal cord stimulation effective?

In a large systematic review of SCS for diabetic neuropathy, researchers found that 63% of patients had more than 50% reduction in pain at the 1-year follow-up.

Resources

Pluijms WA, Slangen R, Joosten EA, et al. (2011). Electrical spinal cord stimulation in painful diabetic polyneuropathy, a systematic review on treatment efficacy and safety. Eur J Pain, 15(8):783–788.