Spinal Cord Stimulator Implant (Neuromodulation) for Failed Back Surgery Syndrome

Failed back surgery syndrome (FBSS) is the generalized term used to describe a condition that occurs following back surgery or spinal surgery. FBSS is characterized by pain and extremity symptoms. With this condition, the patient has continuation of symptoms or new symptoms following spinal surgery.

Why does back surgery not work for everyone?

There are several reasons spinal surgery may not work, even when performed by the best surgeon under optimal circumstances. Reasons for FBSS after surgery include failure to decompress a compressed (pinched) nerve, inability to stabilize a spinal joint, and change in an anatomical lesion (injury) that is a possible cause of the back pain.

How does spinal cord stimulation (SCS) work?

SCS, also known as neuromodulation, uses low voltage stimulation of the spinal nerves to block out the sensations of pain. A small battery-powered generator transmits an electric current to the spinal cord. This causes a tingling sensation, which blocks pain. By interrupting pain signals, the procedure works well for patients with active lifestyles. Neuromodulation devices have been an amazing treatment for patients with chronic pain!

What is a spinal cord stimulator implant?

A spinal cord stimulator is a small device that sends a mild electric current via wires to the spinal cord. When on, the stimulation feels like a mild tingling and pleasant sensation. The pain is reduced because of pain signal transmission interruption. The stimulation will not eliminate the source of pain, but the neuromodulation will interfere with signal transmission to the brain.

What is the most common type of stimulator?

There are several kinds of stimulation systems, with the most common being the internal pulse generator with battery. This SCS system consists of:

• A lead with several electrodes that deliver electrical pulses to the spinal column.
• An implantable pulse generator with battery that creates electrical pulse sensations.
• An extension wire that connects the generator to the lead.
• A hand-held remote that turns the generator on and off and can adjust the pulses.

How often does the battery need to be replaced?

The battery is inside the generator, and it should be replaced every 2 to 5 years. Rechargeable batteries may last up to 20 years, which depends on the usage. The doctor at Bionic Medical Institute will suggest the best system for you.

Who is a candidate for a spinal cord stimulator implant?

Before determining if or not SCS is right for you, the doctor assesses your condition and pain problems. The comprehensive evaluation includes a pain history, your goals of pain management, and your response to the trial period. You may be a candidate if you meet certain criteria, such as:

• Conservative therapies have not worked.
• You will not benefit from another surgery.
• The source of pain has been verified.
• You have experience significant pain for more than 12 months.
• You have radiculopathy (leg symptoms).
• You have no medical conditions that interfere with the procedure.
• You have no psychiatric conditions that contribute to pain.

What happens before surgery?

The doctor will schedule you for some tests several days before surgery. In addition, you must discuss your medications and medical history with the doctor. Blood thinning agents must be held for several days before the procedure. Do not eat or drink after midnight the night before the procedure. Be sure to remove all valuables and jewelry, and arrange to have someone drive you home.

What happens during surgery?

The surgery takes around 1 hour. You are positioned on your side on the operative table. After light sedation is given, your back and stomach regions are shaved and prepped. A local anesthetic is used to numb the skin, and small incisions are made over the spine and in the lower abdomen or buttock.

The surgical leads are placed along the spinal column using fluoroscopy (real-time x-ray). A small portion of the lamina may be removed to allow lead placement. The stimulator device is placed under the skin, and wires are attached from the device to the leads. After this, the incisions are closed with staples or sutures, and a dressing is applied.

What can I expect after the procedure?

You will be monitored in the unit until vital signs are stable. Expect some mild discomfort at the incision sites, as well as mild bruising and some bleeding. Avoid rigorous activities for 6 weeks, avoid sleeping on your stomach, and don’t raise the arms above your head. In addition, you cannot drive for 2-4 weeks, so check with the doctor as to when you can get behind the wheel. Gradually return to normal activities.

Is SCS effective?

In a long-term study, spinal cord stimulation was found to have a 74% success rate. The efficacy rate for SCS varies from 50-90%, depending on the study.

Resources

Kumar K, Nath R, & Toth C (1997). Spinal cord stimulation is effective in the management of reflex sympathetic dystrophy. Neurosurgery 40: 503-509.