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What is the cost of Spinal Cord Stimulation and How it is performed?

  • Posted on- Apr 17, 2018
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Spinal cord stimulation is a therapy that covers pain signals before they reach the brain. A small device which is very similar to a pacemaker is implanted in the body to deliver electrical pulses to the spinal cord. It may be an option if somebody is suffering from chronic back, leg or arm pain and have not found relief with any of the other therapies.

What is a Spinal Cord Stimulator?

A spinal cord stimulator (SCS) is a device which is surgically placed under the skin and sends a mild electric current to the spinal cord. A small wire will carry the current from a pulse generator to the nerve fibers of the spinal cord.

When turned on, the spinal cord stimulator (SCS) stimulates the nerves in the area where the pain is felt. Pain is reduced because the electrical pulses modify and mask the pain signal from reaching the brain.

Stimulation does not eliminate the source of pain it simply interferes with the signal to the brain, so the amount of pain relief varies for each person. Some patients will find the tingling sensation unpleasant.

For these reasons, trial stimulation is performed before the device is permanently implanted. The goal for spinal cord stimulation is a 50-70% reduction in pain. Stimulation does not work for everyone. If unsuccessful, the implant can be removed and does not damage the spinal cord or nerves.

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There are several types of spinal cord stimulator (SCS) device systems. However, all have three main parts:
  • A pulse generator having a battery that creates the electrical pulses.
  • A lead wire with a number of electrodes (8-32) that delivers electrical pulses to the spinal cord.
  • A hand-held remote control that turns the device on and off and adjusts the settings.

The Systems which are having a non-rechargeable battery needs to be surgically replaced every 2 to 5 years, depending on the frequency of use. Rechargeable battery systems may last 8 to 10 years or longer, but the patient must charge the system daily.

Who is a suitable candidate?

An examination of the physical condition, medication regime, and pain history will determine whether the goals of pain management are appropriate for spinal cord stimulator (SCS).

A neurosurgeon, physiatrist, or pain specialist will look at all of the previous treatments, including medication, physical therapy, injections, and surgeries.

Patients selected for spinal cord stimulator (SCS) usually have had chronic debilitating pain for more than 3 months in the lower back, leg (sciatica), or arm. They also typically have had one or more spinal surgeries.

Someone may be a candidate for spinal cord stimulator (SCS) if:
  • Conservative therapies have failed.
  • He would not benefit from additional surgery.
  • The pain is caused by a correctable problem and should be fixed.
  • He does not want further surgery because of the risks or long recovery time. Sometimes spinal cord stimulator (SCS) may be chosen over a large, complex spine surgery.
  • He does not have untreated depression or drug addiction these should be treated prior to having a spinal cord stimulator (SCS).
  • He has no medical conditions that would keep him from undergoing implantation.
  • Spinal cord stimulator (SCS) works well in the earlier stages of a chronic condition before a cycle of pain-suffering-disability-pain is established.

Who performs the procedure?

and pain management specialists (an anesthesiologist or physiatrist) implant spinal cord stimulators.

The surgical decision

Determining whether a spinal cord stimulator will be a good option for anyone is a two-step process. First, one must undergo a temporary trial to see if the device decreases their level of pain.

Stage 1: Trial SCS

Trial stimulation is a kind of "test drive" which is done to determine if an SCS will work for the type, location, and severity of pain. It is performed at an outpatient center.

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A local anesthetic is given to numb the area in the lower back. A hollow needle is inserted through the skin into the epidural space between the bone and spinal cord using X-ray fluoroscopy. The trial lead is placed and positioned over specific nerves. The wires are linked to an external generator worn on a belt.

Stage 2: Permanent SCS

If the trial is successful and the patient experiences greater than 50% improvement in pain, surgery can be scheduled to permanently implant the SCS.

What happens before the surgery?

One may be scheduled for pre-surgical tests (e.g., blood test, electrocardiogram, chest X-ray) several days before the surgery. In the doctor's office, they will sign other forms so that the surgeon knows their medical history (allergies, medicines/vitamins, bleeding history, anesthesia reactions, and previous surgeries).

Discuss all medications (prescription, over-the-counter, and herbal supplements) one is taking with the healthcare provider. Some medications need to be continued or stopped on the day of the surgery.

What happens during the surgery?

There are two parts to the procedure: placement of the lead in the epidural space of the spine and placement of the pulse generator in the buttock or abdomen. The surgery generally takes 1 to 2 hours.

Step 1: Prepare the patient

They will lie on his stomach on the table and be given light sedation. Then, the areas of the patient’s back and buttock are prepped where the leads and generator are to be placed. Local anesthesia will be used to numb the incisions.

Step 2: Place the leads

The electrode leads are inserted with the aid of fluoroscopy (a type of X-ray). A small skin incision is made in the middle of the back, and the bony vertebra is exposed.

Step 3: Test stimulation

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One will be awakened so that he can help the doctor determine how well the stimulation covers the pain pattern. Several stimulation settings will be tried, and he will be asked to describe the location of any tingling felt. These settings will be used to program the pulse generator at the end of surgery, so your feedback is important to ensure the best pain relief.

Step 4: Tunnel the wire

Once the leads are in place, sedation is given again. The lead wire is passed under the skin from the spine to the buttock, where the generator will be implanted.

Step 5: Place the pulse generator

A small skin incision is made below the waistline. The surgeon creates a way for the generator beneath the skin. The lead wire is linked to the pulse generator. The generator is then correctly positioned within the skin pocket.

Step 6: Close the incisions

The incisions are closed with sutures or staples and a dressing is applied.

What happens after surgery?

The patient will wake up in the postoperative recovery area, called the PACU. The blood pressure, heart rate, and respiration will be monitored, and the pain will be addressed. Most patients are discharged on the same day or the following morning. The pulse generator will be programmed before the patient leaves.

What are the tests which have to be performed before the Spinal Cord Stimulation?

Some of the tests which have to be performed before the Spinal Cord Stimulation are:
  1. Blood Test
  2. ECG Test
  3. Chest X-ray

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