Shivam
Pain Management
Centre
Help Line - 079-26301986, 26308976
     
     
 

Spinal Cord Stimulator

    Advantages:

This therapy aims at pain relief in patients who are refractory to all other treatment modalities. They are very tough group to get good results.
There are many advantages of using this therapy like:

1.     It’s a simple Percutaneous/ surgical procedure.

2.     It’s a nondestructive procedure. No permanent surgical or chemical interruption of nerve pathway is done.

3.     A trial therapy checks whether patient is going to get pain relief or not.

4.     The procedure is reversible; if patient is not relieved of his symptoms, the stimulator can be removed. There will not be any side effects.

5.     From patient’s point of view:

 

1.     Significant reduction in pain intensity

2.     Reduction in opioids or other drug intake

3.     Improvement of quality of life.

    Selection criteria:

 

1.     The pain syndrome should be established & patient should have radiating pain.

2.     The conservative treatments have failed.

3.     Drug addiction/alcohol abuse should be ruled out. 

4.     Trial stimulation should be successful.

    Indications:

·         Failed back surgery syndrome

·         CRPS type I & CRPS type II

·         Post herpetic neuralgia

·         Peripheral neuropathy

·         Phantom limb pain/stump pain

·         Peripheral vascular insufficiency

·         Angina

·         Cerebral palsy

·         Multiple sclerosis

    Absolute Contraindications:

The major contraindications are same as mentioned for any procedure:

1.     Infection

2.     Anticoagulants/coagulopathy

3.     Previous surgery or trauma that obliterates spinal cord.

Relative contraindications

1.     Pacemaker in situ.

2.     Major psychiatric problem

3.     Spinal bifida

Disadvantages & complications:

There are certain disadvantages with respect to spinal cord stimulation.

1.     Cost is high compared to other treatment options although is cost-effective.

2.     Requires highly-efficient team.

3.     There may be some complications in rare occasions like lead migration, lead fractures, infection etc.

    Preliminary steps:

1.      Evaluation of pain

2.     Psychiatric evaluation

3.     Patient education: about pre- and post-procedure plan and long-term management, cost effectiveness

4.     Planning of procedure.

    Procedure

The procedure involves percutaneous insertion of lead, typically a ‘longitudinal’ lead with a linear array of electrodes through an epidural needle into the epidural space and oriented parallel to spinal column. First step is the introduction of a trial electrode for temporary purpose. The lead is connected to an external battery source that transmits radiofrequency signals to the lead. The external transmitters help in adjusting the amplitude, pulse width and rate of stimulation. The low voltage electrical stimulation is applied to the spinal cord to create a current field that activates neurons in the dorsal column. This stimulation is done by the external power supply connected to lead by either a conducting wire or extension. The stimulation produces paraesthesia that interferes with or blocks pain signals to brain. The vertebral level at which it is placed depends upon the location of pain. If patient gets 50% or more pain relief after trial stimulation, then patient is considered for permanent implant. Replacing the temporary lead with permanent lead usually does this. Implanted pulse generator provides the power supply.