Spinal cord stimulation (SCS) is a neuromodulation therapy that uses electrical impulses to block or modify pain signals before they reach the brain.
Spinal cord stimulation is indicated for chronic, intractable pain—especially neuropathic pain—that has not responded adequately to conservative treatments. The goal is to reduce pain, improve function, and decrease reliance on medications, especially opioids.
Common Indications:
– Failed Back Surgery Syndrome (FBSS) / Post-Laminectomy Syndrome
Persistent radicular leg or back pain after spine surgery
– Complex Regional Pain Syndrome (CRPS)
Can involve upper or lower extremities
Refractory to medications, physical therapy, or sympathetic blocks
– Painful Neuropathy
Burning, tingling, aching due to disruption of nerve fibers
– Chronic abdominal or pelvic pain
Spinal cord stimulation treatment is a two-step process. The first step is a trial period in which thin wires, called electrodes, are temporarily inserted under the skin and into the spinal space corresponding to the pain source.
This step is comparable to an epidural injection; however instead of placing medication, we place electrodes. The electrode leads are then secured and left in place for up to a week to test if you receive a significant reduction in pain symptoms. If the trial is effective, we then decide if implanting the device for long-term use is right for you.
The first step to determine your eligibility to receive a spinal cord stimulator is to perform a thorough physical examination and carefully consider your medical and family history.
-Blood thinners (e.g., aspirin, Plavix, Eliquis, warfarin):
You will need to stop them before the procedure to reduce bleeding risk. Only do this under medical supervision.
– Medical Clearance (if needed)
If you have heart conditions, bleeding disorders, or infections, your provider may require clearance from your primary doctor or specialist.
During the spinal cord stimulator trial, the temporary wires are inserted into the spinal space and is usually performed in under 20 minutes with the patient’s ability to go home the same day after a short recovery period. These wires are adhered to the back to continuously deliver the therapy to reduce pain. There may be some soreness over the area, however this is minimal. Once the trial is completed (typically 7 days) then you return to clinic where the wires are removed.
If the spinal cord stimulator trial provided significant relief, then we discuss using them for long term pain management. In this case, we implant the spinal cord stimulator via a surgical procedure. A small incision is created to insert the electrodes in the epidural space surrounding the spinal cord. Those electrodes are then passed through the skin and into the upper buttock area, where the pulse generator (battery) will be implanted. It is usually performed in under 90 minutes with the patient’s ability to go home the same day after a short recovery period.