PROCEDURE
Research studies have demonstrated the effectiveness of SCS in managing peripheral neuropathy pain. By targeting the dorsal columns of the spinal cord (Nerves on the back side of the spinal cord), SCS can “turn off” the pain like a light switch and provide significant relief for patients who have not responded well to other treatments. Custom programming of SCS allows healthcare providers to adjust stimulation parameters to fit the individual needs of each patient; so that optimal pain relief can be achieved in all patients.
Find out if you are a candidate
The exact way by which SCS eliminates neuropathic pain is not fully understood, but several theories have been proposed. One popular theory suggests that SCS activates inhibitory pathways in the spinal cord, which then blocks the transmission of pain signals to the brain. Also, SCS may trigger the release of endogenous opioids (Body’s natural pain killer) and other neurotransmitters (chemicals) that help to reduce pain perception.
Before undergoing SCS for peripheral neuropathy pain, patients and providers should consider the following:
- Patient selection needs: Not all individuals with neuropathic pain may be good candidates for SCS. A thorough history and physical by a pain management specialist is important to determine eligibility.
- Trial period: Prior to implanting a permanent SCS device, all patients must undergo a trial period during which temporary leads are placed to assess whether good pain control can be achieved.
- Device programming and maintenance: Regular follow-up appointments are needed to adjust stimulation settings as needed and to ensure the proper functioning of the SCS system.
The steps involved in this procedure?
1.Patient Evaluation: Before the procedure, the patient has to undergo a comprehensive evaluation by a pain management physician. This evaluation includes a review of all prior medical history, physical examination, radiology imaging studies (such as MRI or CT scans), and usually a psychological assessment to determine if the patient is a suitable candidate for SCS.
2.Trial Period: All patients undergo a trial period to assess the effectiveness of spinal cord stimulation in reducing their pain before putting in the permanent device. During this trial, temporary leads are inserted into the epidural space on top of the spinal cord via a small needle after local anesthesia is administered. The leads are then connected to an external stimulator device that the patient wears outside the body. The patient then assesses the level of pain relief and functional improvement during this trial period which typically lasts 5 to 7 days.
3.Finalizing the Plan: Once the patient reports that the trial is successful and the patient experiences significant pain relief and improvement in function (more than 50% in pain improvement), a decision is made to proceed with the permanent implantation of the spinal cord stimulator system.
4.Preparation for Surgery: Prior to the surgery, all patients will need to undergo routine preoperative evaluations, which will include blood work, electrocardiogram (ECG), and additional imaging studies if needed. The patient is then instructed on fasting guidelines and any necessary medication adjustments prior to the day of the procedure.
5.Surgical Procedure: The patient is brought to a sterile operating room and the implant is placed under sterile conditions. The surgery is usually performed under general anesthesia, although in some cases, local anesthesia with conscious sedation is used especially when general anesthesia may be too risky for the patient. Specific surgical implantation techniques may vary depending on the type of spinal cord stimulator system being implanted and the patient’s anatomy, however the general steps involve:
- Incision: The physician will make a small incision in the lower back at the site where the leads will be implanted. Also, the leads can sometimes be placed through a small incision in the chest or abdomen, depending on the preferred approach by the physician.
- Lead Placement: Using fluoroscopic guidance (real-time X-ray imaging), the physician inserts 2 thin leads that look like fishing strings into the epidural space on top of the spinal cord. The leads are then positioned with precision to target the specific areas of the spinal cord associated with the patient’s pain pattern.
- Implantable Pulse Generator (IPG) Placement: Next, a small incision is made in the lower back or flank area, and a pocket is made in the fatty tissue under the skin to accommodate the IPG battery, which is the device that generates electrical impulses. This IPG is then implanted into the pocket made under the skin and connected to the leads via thin extension like electrical wires.
- Testing: Once the leads and IPG are in the right place, the physician tests the system to ensure proper positioning and functionality. Sometimes the patient is awakened to get verbal confirmation of good pain coverage. This usually involves programming the stimulation parameters to optimize pain relief while minimizing any side effects such as mild tingling sensation if uncomfortable.
- Closure: After confirming proper programing of the spinal cord stimulator system, all incisions are closed with sutures or surgical staples, and sterile dressings are applied.
6.Postoperative Care: After the procedure, the patient is monitored in a recovery area until they are stable and awake. Pain medication and instructions for wound care are given to the patient and to any companion assisting the patient. Depending on the specific circumstances, most if not all patients are discharged home on the same day.
7.Follow-Up: Regular follow-up appointments at the doctor’s office are scheduled to monitor the patient’s progress, to adjust the stimulation programing as needed, and to address any concerns or complications that may arise.