What Is Spinal Cord Stimulation BY LAXMAIAH MANCHIKANTI, MD N eurostimulation, also known as neuromodula- tion, is the purposeful modulation of nervous system activity using microelectrodes. A spinal cord stimulator (SCS), also known as a dorsal column stimulator (DCS), is a type of implantable neuromodula- tion device, sometimes called a pain pacemaker, that is used to send electrical signals to select areas of the spinal cord for the treatment of certain painful conditions. Those suffering with chronic pain have probably had many alternative treatments without long-lasting or inadequate help. In such cases, spinal cord stimulation can be an effective therapy. Spinal cord stimulation + Two leads are placed into the spine and they send low levels of electricity directly into the spinal cord to relieve pain. An electrical nerve stimulation device is implanted into your body to control chronic pain local neurochemistry in the dorsal horn, suppressing hyperexcitability of neurons. Spinal cord stimulation restores the Selection Criteria Selection criteria for spinal cord stimulation trial and placement are very stringent. Suitability of the procedure is judged by physical condition, psychological status, and the relief obtained from the trial. 1. Psychological Evaluation Psychological evaluation is essential prior to placement. Understanding of the implant is crucial. 2. Lack of Risk of Bleeding 3. Technical Considerations Variations in anatomy are assessed, which may preclude successful placement in certain individuals. is used for the treatment of chronic and oxygen demand supply, and vasodilation Adverse Effects and intractable pain, including: 1. Post-surgery syndrome (or failed back surgery syndrome) 2. Complex regional pain syndrome (previously called Reflex Sympathetic Dystrophy, or RSD) 3. Nerve-related pain including: Diabetic neuropathy Radiation neuropathy Chemotherapy neuropathy Neuropathy after exposure to chemicals 4. Phantom limb pain 5. Ischemic limb pain 6. Chronic pain How does it work? Multiple theories have been proposed; however, none provide a full explanation. Spinal cord stimulation involves masking pain sensation with or without tingling by altering the pain processing of the central nervous system. Spinal cord stimulator alters the or combination of multiple mechanisms. Surgery for stimulation Spinal cord stimulators are placed in two different stages. Initially, a trial is performed leaving the stimulator for several days so that one can judge the acceptability and the pain relief they obtain. This is performed as a sterile surgical technique procedure in the operating room; however, without any incisions. This is similar to epidural injection, but with larger needles, and the leads are kept in the body. Two leads are placed into the thoracic spine or mid back for low back pain and at higher levels for mid back and neck pain under x-ray guidance. If the patient experienced good pain relief without any side effects, at least around 60% or so, a permanent stimulator may be placed percutaneously without cutting the bone in the mid back, or with laminotomy with cutting some of the bone in thoracic spine area in the mid back area. The leads are tunneled and connected to the battery in the low back or abdominal area or over the hip. Complications Most of the complications are simple and easily correctable problems. However, devastating paralysis, nerve injury and death may occur in a small proportion of patients. The most common complications include loss of effectiveness as time passes on, lead migration, lead breakage, and infection. Precautions A spinal cord stimulator may set off airport security. Driving with spinal cord stimulator, power on is not recommended. You should power off your stimulator when you are driving or operating heavy machinery. You can swim with a permanent spinal cord stimulator. Spinal cord stimulator can be removed if there is a complication, or it does not work any longer. Pain Management Centers of America has qualified physicians in Kentucky, Indiana, Illinois, and Tennessee that offer spinal cord stimulation. PAIN MANAGEMENT OFFERING TELEMEDICINE SERVICES CENTER PAIN MANAGEMENT CENTERS OF AMERICA 270-554-8373 pmcoa.us 090122-AD-PS-WHAT-SPINAL CORD-STIMULATION-MA MEETING THE HEALTH NEEDS OF PATIENTS WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, AGE, OR NATIONAL ORIGIN What Is Spinal Cord Stimulation BY LAXMAIAH MANCHIKANTI , MD N eurostimulation , also known as neuromodula- tion , is the purposeful modulation of nervous system activity using microelectrodes . A spinal cord stimulator ( SCS ) , also known as a dorsal column stimulator ( DCS ) , is a type of implantable neuromodula- tion device , sometimes called a pain pacemaker , that is used to send electrical signals to select areas of the spinal cord for the treatment of certain painful conditions . Those suffering with chronic pain have probably had many alternative treatments without long - lasting or inadequate help . In such cases , spinal cord stimulation can be an effective therapy . Spinal cord stimulation + Two leads are placed into the spine and they send low levels of electricity directly into the spinal cord to relieve pain . An electrical nerve stimulation device is implanted into your body to control chronic pain local neurochemistry in the dorsal horn , suppressing hyperexcitability of neurons . Spinal cord stimulation restores the Selection Criteria Selection criteria for spinal cord stimulation trial and placement are very stringent . Suitability of the procedure is judged by physical condition , psychological status , and the relief obtained from the trial . 1. Psychological Evaluation Psychological evaluation is essential prior to placement . Understanding of the implant is crucial . 2. Lack of Risk of Bleeding 3. Technical Considerations Variations in anatomy are assessed , which may preclude successful placement in certain individuals . is used for the treatment of chronic and oxygen demand supply , and vasodilation Adverse Effects and intractable pain , including : 1. Post - surgery syndrome ( or failed back surgery syndrome ) 2. Complex regional pain syndrome ( previously called Reflex Sympathetic Dystrophy , or RSD ) 3. Nerve - related pain including : Diabetic neuropathy Radiation neuropathy Chemotherapy neuropathy Neuropathy after exposure to chemicals 4. Phantom limb pain 5. Ischemic limb pain 6. Chronic pain How does it work ? Multiple theories have been proposed ; however , none provide a full explanation . Spinal cord stimulation involves masking pain sensation with or without tingling by altering the pain processing of the central nervous system . Spinal cord stimulator alters the or combination of multiple mechanisms . Surgery for stimulation Spinal cord stimulators are placed in two different stages . Initially , a trial is performed leaving the stimulator for several days so that one can judge the acceptability and the pain relief they obtain . This is performed as a sterile surgical technique procedure in the operating room ; however , without any incisions . This is similar to epidural injection , but with larger needles , and the leads are kept in the body . Two leads are placed into the thoracic spine or mid back for low back pain and at higher levels for mid back and neck pain under x - ray guidance . If the patient experienced good pain relief without any side effects , at least around 60 % or so , a permanent stimulator may be placed percutaneously without cutting the bone in the mid back , or with laminotomy with cutting some of the bone in thoracic spine area in the mid back area . The leads are tunneled and connected to the battery in the low back or abdominal area or over the hip . Complications Most of the complications are simple and easily correctable problems . However , devastating paralysis , nerve injury and death may occur in a small proportion of patients . The most common complications include loss of effectiveness as time passes on , lead migration , lead breakage , and infection . Precautions A spinal cord stimulator may set off airport security . Driving with spinal cord stimulator , power on is not recommended . You should power off your stimulator when you are driving or operating heavy machinery . You can swim with a permanent spinal cord stimulator . Spinal cord stimulator can be removed if there is a complication , or it does not work any longer . Pain Management Centers of America has qualified physicians in Kentucky , Indiana , Illinois , and Tennessee that offer spinal cord stimulation . PAIN MANAGEMENT OFFERING TELEMEDICINE SERVICES CENTER PAIN MANAGEMENT CENTERS OF AMERICA 270-554-8373 pmcoa.us 090122 - AD - PS - WHAT - SPINAL CORD - STIMULATION - MA MEETING THE HEALTH NEEDS OF PATIENTS WITHOUT REGARD TO RACE , COLOR , RELIGION , SEX , AGE , OR NATIONAL ORIGIN