Pros And Cons Of Spinal Stimulation Surgery

Low back pain is a condition that affects millions of Americans every day. The pain can be debilitating and often leads to missed social engagements, days off work, and even disability claims.

In order to manage this pain, researchers developed spinal cord stimulators. A spinal cord stimulator is a device that is implanted into the area around your spine and it is used to send low levels of electricity directly into your spinal cord to relieve the pain.

What Are Spinal Cord Stimulators?

Spinal cord stimulators consist of thin wires, known as electrodes, with a small generator/battery pack. The electrodes are placed between the spinal cord and vertebrae while the generator is placed under the skin, near the glutes or the abdomen. Whenever the patient feels pain they can send electrical impulses to the spine using an external remote control.

The science behind spinal cord stimulation suggests that the device targets the muscle groups directly from the spine and can alter how the brain senses pain. Feelings of pain are replaced with a light tingling feeling that is known as paresthesia.

While most patients are relieved to be free of the pain, some individuals can find the paresthesia uncomfortable. There are newer models of spinal cord stimulators that have been designed to address this issue by offering “sub-perception” which is stimulation that most patients don’t feel at all.

Types of Chronic Pain that Spinal Cord Stimulators Treat:

1. Back pain

2. Spinal cord injuries

3. Failed back surgery syndrome

4. Post-surgical pain

5. Arachnoiditis

6. Nerve pain (eg. diabetic neuropathy)

Typically spinal cord stimulators are used when other nonsurgical treatment options have failed.

How Effective Are Spinal Cord Stimulators?

So how do you know if spinal cord stimulation will work for you? Your doctor will want to make sure that the treatment will be a good fit for you and will probably order a psychological screening along with imaging tests. Psychological screening is often required by insurance companies to make sure that your pain isn’t being made worse by conditions like depression or anxiety which can play a major role in how people with low back pain experience their condition.

Who Is A Good Candidate For Spinal Cord Stimulation Surgery?

While everyone experiences pain differently, researchers have found that the types of people who benefit the most from spinal cord stimulation are:

• Those who have had failed surgeries

• People that medication hasn’t worked for

• Individuals who do not have psychiatric conditions (like depression or anxiety) that may decrease the effectiveness of the treatment.

Doctors can run a trial test with the stimulator to see if it will be a good option before they do the implant surgery. If your pain decreases by 50% or more you are considered to be a good candidate for spinal cord stimulation.

Types Of Spinal Cord Stimulators

1. IPG (implantable pulse generator). This is a battery operated spinal cord stimulator. It has a lower electrical output so it is a good option for those with pain that is specific to one part of the body. During the operation a battery is placed in the spine, but when the battery runs out it will have to be replaced with a new one and will require another surgery.

2. Rechargeable IPG. This device is similar to the regular IPG but the battery is rechargeable. Not only does this device not require a second surgery to replace the battery but it has a higher electrical output which means the signal can reach further and address pain in the lower back more efficiently.

3. Radiofrequency stimulator. This type of device uses a battery that is located outside the body. It has rechargeable batteries but it is rarely used these days because the technology is outdated and there are newer, better devices available on the market.

What To Expect In Terms Of Recovery From Spinal Cord Stimulation Surgery

Quite often spinal cord stimulation surgery is done as a day surgery and many patients leave the hospital the same day as the surgery. The incisions can be painful for a few days post-surgery and you should not stretch, twist, or reach too much as that can pull at your incisions.

Dressing should be removed about 3 days after the procedure and you should avoid bathing, swimming, and hot tubs for a while. Generally the incisions will heal within about 2-3 weeks after the surgery.

You should take things easy for a couple of weeks but once your surgeon approves you for regular activity you can return to normal activities such as working and driving again.

The Pros And Cons Of Spinal Cord Stimulation

So, what are the pros and cons of spinal cord stimulation? If you are considering this type of treatment for your lower back pain it is a good idea to look at the pros and cons of this therapy.

Pros Of Spinal Cord Stimulation

1. Can improve quality of life with reduced pain

2. Reduces the need for pain medications

3. Provides meaningful pain relief to at least 50% of patients

4. Improved functioning

5. Improved sleep

6. Reduced opioid use

Cons Of Spinal Cord Stimulation

1. Risky surgical procedure (blood loss, allergic reactions)

2. Treatment failure

3. Expensive (costs can range from $7,000 to over $10,000)

4. Headaches

5. Shooting pain in arms and legs

6. Pneumothorax

7. Allergic reactions

8. Nerve damage

9. Paralysis

10. Shifting of the leads (can send stimulation to the wrong part of the body)

11. Tolerance build-up

12. Fluctuations in stimulation

13. Reaction to pressure

14. Electromagnetic interference

Clinical Considerations

A recent study led by Sanket S. Dhruva, MD, MHS, of the University of California San Francisco School of Medicine, found that 'those who had a permanent SCS implanted had higher odds of chronic opioid use during the first 12 months compared with those treated with conventional strategies'.

The researchers also found that "the lack of reduction in pharmacotherapy, epidural and facet corticosteroid injections, and radiofrequency ablations at 2 years among patients receiving SCS compared with those receiving CMM suggests that SCS was providing insufficient pain relief to forego other therapies or improve rates of depression or anxiety, as prescriptions for these drug classes did not decline."

While the authors of the study did acknowledge that some of the newer devices may have better results but they also caution that 22% of people needed their devices revised or removed. When you consider that the average cost of the device is around $40,000 more than conventional treatment, that is definitely something to consider before you commit to the treatment.

Conclusions

Spinal cord stimulation is a useful tool in the fight against low back pain but it is important to remember, that just like most pain relieving tools, the effects vary from person to person. For some people it is important to remember that spinal cord stimulation may not work for everyone and for some people, while it may reduce the pain, it won’t necessarily eliminate it altogether. Oftentimes spinal cord stimulation is considered to be successful if the pain is reduced by at least 50% but not everyone actually reaches that goal.

Another important consideration is that even after a successful trial, the device may not give the expected levels of relief after the actual surgery and implantation. Many patients can decide for themselves if they want to keep the device or not in the long run. Typically doctors let patients live with the stimulator for two to three years before considering removal.

If you are considering spinal cord stimulation surgery then it is a good idea to discuss things with your healthcare provider and see what non-surgical options you might want to try before you embark on this journey.