What is spinal cord stimulation?
Spinal cord stimulation is a type of neuromodulation that effectively treats neuropathic (nerve-related) pain. It involves placing a tiny electrical wire (electrode) near the spinal cord; this is connected to an electrical device (pulse generator) that sends out small electrical impulses to reduce the feeling of pain.
The first fully-implantable spinal cord stimulation was trialled in the 1970s and it has since revolutionised the management of chronic pain. A spinal cord stimulation system is usually first temporarily implanted in the body as a trial before being permanently implanted.
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What is it used to treat?
This highly-targeted method of neuromodulation can be used to treat specific sites of pain in the body (such as after back surgery that has been ineffective) or more generalised pain (such as with complex Regional Pain Syndrome).
Failed back surgery syndrome and failed neck surgery syndrome
Spinal cord stimulation has played a role in the treatment of failed back surgery syndrome and failed neck surgery syndrome for over 20 years. These syndromes are described as persistent or recurring pain in the lower back or neck, respectively, after one or more spinal surgeries. It can occur with or without sciatica (pain down the back of the leg caused by irritation of the sciatic nerve).
Despite advances in spinal surgery, there are still many patients suffering from failed back surgery syndrome and failed neck surgery syndrome. Spinal cord stimulation has been shown to reduce the amount of pain medication required, reduce pain scores (patients’ measures of their pain), improve everyday functions, and improve quality of life in these patients.
Complex regional pain syndrome
This is a condition when someone experiences pain that is out of proportion to the underlying injury. It usually affects one limb (arm, leg, hand or foot) and is divided into two types: type 1 is pain without nerve injury, and type 2 is pain with nerve injury.
Painful peripheral vascular disease
Progressive blockage of the arteries that supply blood to the limbs can cause a condition known as peripheral vascular disease. For some people, this can cause longstanding pain, particularly in the lower legs. Spinal cord stimulation can be used to reduce the pain associated with chronic painful peripheral vascular disease, and has also been found to improve the condition and reduce the likelihood of amputation.
Chronic angina pectoris
Spinal cord stimulation has been found to successfully treat chronic angina pectoris, a chest pain caused by coronary artery disease. This is usually an option for patients whose pain has not been relieved by medication and who are not suitable for other forms of heart surgery.
How is it performed and what is involved?
Spinal cord stimulation can be implanted initially on a temporary basis as a trial. The electrical device, or pulse generator, is kept outside the body and the electrodes are placed through the skin. This trial placement allows the settings to be easily adjusted and gives the patient and specialist team an opportunity to see how effective the spinal cord stimulation system is in treating the pain. It also allows the specialist to find the best positioning for a future permanent spinal cord stimulation system.
Implanting a more permanent spinal cord stimulation system in the body requires surgery. Depending on each patient’s requirements, they may need a procedure called a laminectomy (the removal of a small part of the vertebrae) to provide the access needed to place the electrodes.
Spinal cord stimulation is considered to be relatively safe, however, as with any procedure there are always some risks to consider:
The vast majority of complications are non-life-threatening events related to failure of the device. These risks include:
- Failure of the device to sufficiently reduce pain
- Wearing off of the treatment effects over time
- Breakage of the electrode(s)
- Malfunction of the electrode(s)
- Migration of the electrode(s) from the intended location.
Other risks include:
- Pain at the site of insertion
- Infection at the site of insertion
- A collection of fluid called a seroma.
More serious complications are extremely rare, but include:
- A small risk of injury to the spinal cord during placement of the electrodes
- A small risk of blood collecting in the epidural space (outermost part of the spinal canal), called a haematoma, which may require further surgery.
How effective is it?
A medical specialist will view spinal cord stimulation treatment to be successful if a patient’s symptoms are reduced by at least 50%.
Spinal cord stimulation has been extensively studied in a number of diseases and has been found to be quite effective in treating longstanding pain that failed to respond to conventional treatments. A recent study showed very strong evidence for the use of spinal cord stimulation in the treatment of lower back failed back surgery syndrome. Similarly, many studies have shown that spinal cord stimulation provides better pain control, improved function and an overall better quality of life when compared to other treatments for a range of other pain syndromes. These include trunk and limb pain, complex regional pain syndrome (pain caused by damage or malfunctioning nerves, resulting in long term pain), diabetic neuropathy (nerve pain resulting from diabetes) and angina pectoris (cardiac chest pain), that isn’t helped by other treatments.
Why choose The London Clinic?
Here, at The London Clinic, we offer access to leading specialists in the field of neuromodulation, the very best facilities and equipment and clinical support teams that are second to none. Our multi-disciplinary team will support each patient through their treatment and recovery, as well as with the long-term maintenance and programming of their spinal cord stimulation device.
What the experts say...
We offer the latest types of spinal cord stimulation from all the major manufacturers, selecting between awake cylindrical to asleep paddle leads and rechargeable or recharge free stimulators together with you for best result. We have an established experience in complex and revision surgeries.