Spinal Cord Stimulation Treatment in Northern New Jersey

What Is a Spinal Cord Stimulator?

The first spinal cord stimulator was used in 1968. Since then, spinal cord stimulation has continued to become more and more beneficial for a number of different spinal nerve related pathologies because the technology is so advanced. A spinal cord stimulator is an implanted medical device that interrupts pain signals from the spine to the brain. If a patient’s back pain cannot be resolved with surgery or conservative treatment methods, they may be a candidate for spinal cord stimulation. Most patients undergo a trial with a spinal cord stimulator before they have surgery to permanently implant the device.

The spinal cord stimulator automatically blocks pain signals. The patient can turn off the stimulator when needed, such as when they are driving. Spinal cord stimulation can be used to treat chronic pain caused by conditions such as:

• Neuropathy: Caused by nerve damage, this condition leads to weakness, numbness, and pain from nerve damage, usually in the hands and feet. It can result from traumatic injuries such as a crushing injury, as well as from conditions such as diabetes.
• Failed back surgery syndrome (FBSS): Chronic pain from FBSS can be caused by poor healing processes, subsequent disease, or an injury after surgery. FBSS can cause sharp or aching pain in the back or legs, as well as weakness in the limbs.
• Spinal cord injuries: Trauma to the spinal cord can be caused by an athletic injury, a car crash, or a work-related injury. Fractures or dislocations can put pressure on the surrounding nerves, leading to chronic nerve pain.
• Arachnoiditis:This condition is caused by inflammation of the arachnoid, the membrane that protects the nerves in the spinal cord, and can lead to severe stinging or burning pain in the back.

Diagnosis of Back Pain

Not every patient with back pain should receive a spinal cord stimulator. If a patient has acute or chronic back pain, a doctor will recommend more conservative treatments first, then advance as indicated.  Imaging tests, such as magnetic resonance imaging (MRI), will help determine the cause of a patient’s back pain. Traditionally, the course will be:

• Physical therapy: Structure physical therapy can strengthen the muscles and ligaments in the back to help reduce chronic pain.
• Medications: Pain medication or steroid medication to reduce swelling may provide temporary relief.
• Epidural steroid injections: This type of injection treatment can reduce pain and inflammation for weeks or even months at a time.
• Spine surgery: Some spinal injuries and deformities that cause chronic pain can be corrected with surgery.

A spinal cord stimulator is only indicated if the above treatment methods are not effective or are not indicated according to the medical guidelines. Some insurance companies also require psychological screening before they will authorize a patient for a trial spinal cord stimulator. A trial of a spinal cord stimulator is to confirm whether the technology relieves the patient’s discomfort. If it does, then the lead placement is documented as to where placement alleviates the patient’s pain and then connected to a very small external battery. During a permanent placement of the spinal cord stimulator, a battery for the spinal cord stimulator is implanted under the skin so the patient can move without being connected to any external battery.

Procedure and Recovery

After a patient has attempted other forms of treatment but failed to experience significant relief, the patient is now a good candidate for spinal cord stimulation. If the patient chooses to trial the technology, they will first undergo a procedure to experience whether a temporary spinal cord stimulator device resolves their discomfort sufficiently. Using X-ray guidance, the pain management doctor or surgeon will insert electrodes in the epidural space of the spine via an epidural needle. This non-invasive procedure typically requires only IV sedation and one small epidural needle. After completion, the patient will wear a small external generator usually attached to their belt, to control the stimulation of the spinal cord stimulator electrodes. The trial period is usually for one to two weeks so the patient can get a sense of how well the device reduces their pain. If the stimulator is effective, the patient qualifies for a permanent implantation procedure.

During the permanent placement of the stimulation leads, electrodes, and their battery, the pain management doctor along with a neurosurgeon places the small battery a.k.a. generator, underneath the skin and replaces the trial electrodes with new electrodes. One small incision just underneath the surface of the skin of the abdomen or at the point where the lower back transitions to the top of the buttocks, will be made to insert the small generator. Another extremely small incision, less than 1 centimeter, just under the surface of the skin midline to the level of the spine will be made to insert the permanent electrodes. The neurosurgeon will use fluoroscopy to guide the implantation of the electrodes and ensure they are correctly placed. The implantation surgery typically takes one hour and can be performed as an outpatient procedure using local anesthesia and IV sedation. A patient will go home on the same day.

After the surgery, a patient should avoid stretching, twisting, heavy lifting, and strenuous activity for the first couple of weeks after surgery. Many patients can return to work and drive one week or less after the procedure. Their doctor will schedule one or more follow-up appointments to ensure the incisions are healing and that the stimulator device is working correctly. The implant is small and typically not visible.

Each patient is different, so the degree of pain relief that a spinal cord stimulator provides can vary. Some patients can reduce their dosage of pain medication or stop taking it entirely. According to the U.S. National Library of Medicine, the stimulator device’s battery can last two to five years, although some generators have rechargeable batteries. Minor surgery is required to replace the battery. The surgical procedure is simply an exchange of the old battery with the new battery.  The electrodes and leads remain in place and are just reconnected to the new battery.

Expertise in Pain Management

Recognized as a National Spine Center of Excellence since 2008, Centers for Neurosurgery, Spine & Orthopedics (CNSO) is led by award-winning neurosurgeons, orthopedic spine doctors, pain management and physical therapists. The medical team works collaboratively to provide a personalized treatment plan for each patient. To serve a broader population of patients, CNSO is staffed by physicians and nurses who speak the following languages in addition to English:

• Spanish
• Mandarin Chinese
• Russian
• Korean
• Serbo-Croatian

Count on CNSO for Compassionate Care

At Centers for Neurosurgery, Spine & Orthopedics, patients will find the latest advancements in pain management for back and spine conditions. CNSO serves patients in northern New Jersey and the surrounding area and offers a variety of treatment options, including spinal cord stimulator treatments. To learn more about spinal care at CNSO or schedule an appointment, contact us today.