Epidural spinal cord stimulation is a medical therapy for chronic pain. It involves surgically implanting a small device that delivers mild electrical impulses to the spinal cord. This aims to alter pain signals before they reach the brain, providing relief for individuals who have not found comfort through other conventional methods.
Understanding Epidural Spinal Cord Stimulation
Epidural spinal cord stimulation operates by delivering electrical impulses directly to the spinal cord, which can modify how pain signals are perceived. The system consists of two primary components: a small, battery-powered generator and thin, insulated wires known as leads. The generator, similar in size to a pacemaker, is implanted beneath the skin, often in the abdomen or upper buttock.
The leads are positioned within the epidural space, a region between the bony vertebrae and the protective membrane surrounding the spinal cord. These leads contain electrodes that emit electrical pulses. These impulses interfere with pain signal transmission to the brain, often replacing pain with a tolerable tingling (paresthesia) or simply reducing it. Lead placement is tailored to target specific nerve pathways associated with the patient’s chronic pain.
Conditions Addressed by Spinal Cord Stimulation
Spinal cord stimulation is considered for individuals experiencing persistent chronic pain that has not responded to more conservative treatments. One common indication is Failed Back Surgery Syndrome (FBSS), a condition characterized by ongoing or recurring back and leg pain following spinal surgery. This pain can stem from nerve damage, scar tissue, or continued disc issues.
Complex Regional Pain Syndrome (CRPS) is also addressed. CRPS involves chronic pain, usually affecting an arm or leg, often developing after an injury, stroke, heart attack, or surgery. The pain is disproportionate to the original injury and can be accompanied by swelling, changes in skin temperature, and alterations in skin texture. Neuropathic pain, which arises from nervous system damage or dysfunction, is another target for this therapy. This includes pain from diabetic neuropathy, post-herpetic neuralgia (pain after shingles), or nerve damage from trauma.
The Spinal Cord Stimulation Procedure
The process of receiving an epidural spinal cord stimulator involves two distinct phases: a trial period and, if successful, permanent implantation. The trial period is an outpatient procedure, usually lasting between three and seven days. During this phase, temporary leads are inserted into the epidural space through a needle, similar to an epidural injection, without requiring a large incision.
These temporary leads are connected to an external battery pack and controller, which the patient wears outside their body. This allows the individual to test the stimulation’s effectiveness in managing pain during daily activities. The medical team adjusts settings to find optimal stimulation parameters that provide significant pain relief. If the trial is successful, the patient may then proceed to permanent implantation.
Permanent implantation is a surgical procedure, often performed with minimally invasive techniques. During this surgery, the leads are positioned in the epidural space and secured to prevent movement. A small incision is made, typically in the lower abdomen or upper buttock, where the pulse generator is implanted just beneath the skin. Patient selection requires that conservative pain management strategies have been exhausted and that the individual undergoes a psychological evaluation to ensure suitability for living with the device.
Living with Spinal Cord Stimulation
After permanent implantation of an epidural spinal cord stimulator, individuals can expect a significant reduction in chronic pain, though complete elimination is uncommon. Many report improved ability to perform daily activities, better sleep quality, and decreased reliance on pain medications. The device is programmed by a healthcare professional, and patients receive a handheld remote control that allows them to adjust stimulation settings within physician-set limits to optimize comfort throughout the day.
The device’s management depends on its battery type. Rechargeable systems require regular charging, which can range from daily to weekly sessions depending on usage intensity and battery model. Non-rechargeable batteries have a lifespan of approximately two to five years, after which a minor surgical procedure is needed for replacement.
Most daily activities can be resumed, though individuals are advised to carry an identification card for airport security screenings, as the device may trigger metal detectors. Strong electromagnetic fields, such as those from certain medical imaging procedures, may need to be avoided or managed with specific protocols. While the goal is improved quality of life, changes in sensation or mild irritation at the implant site can occur.