Overview
A spinal cord stimulator, also called a dorsal column stimulator, is an implanted electronic device used to help treat chronic pain. They have been used for over 30 years. The device delivers a low level electrical current through wires. The wires are placed in the area near your spinal cord. The device is similar in size to a pacemaker.
The spinal cord stimulator will not cure your pain. A 50 percent or greater decrease in pain can be expected, however. This should allow you to be more active. Also, need for less pain medication is considered a successful result. A trial with an external device for about a week is done, before having the device implanted.
The cervical spinal column is made up of vertebral bodies which protect the spinal cord.
Indications
Cervical spine disease is usually caused by herniated intervertebral discs, abnormal growth of bony processes on the vertebral bodies (osteophytes), which compress spinal nerves, trauma, and narrowing (stenosis) of the spinal column around the spinal cord.
Symptoms of cervical spine problems include:
Pain that interferes with daily activitiesNeck pain that extends (radiates) to the shoulder or armWeakness of arms or legsNumbness of arms, hands, or fingersIncision
The surgery is done while the patient is deep asleep and pain-free (general anesthesia). For the neck (cervical spine), an incision may be made either in the back of the neck (posterior cervical) or in the front side of the neck (anterior cervical), depending on the location of the problem.
Procedure
The bone that curves around and covers the spinal cord (lamina) is removed (laminectomy) and the tissue that is causing pressure on the nerve or spinal cord is removed. The hole through which the nerve passes can be enlarged to prevent further pressure on the nerve. If an intervertebral disc herniation is present, the intervertebral disc is removed. Sometimes, a piece of bone (bone graft) or metal rods (such as Harrington rods) may be used to strengthen the area of surgery.
How should I prepare for surgery?
The surgery usually takes place in a Same Day Surgery facility. An operating room is considered sterile and decreases the risk of infection. The procedure may last up to three hours. You should be able to go home the same day.
Before either the trial or the surgery for implanting a spinal cord stimulator, your surgeon will discuss the preoperative guidelines. Follow your surgeon's instructions.
These instructions may include :
- Do not eat or drink for at least six hours before the procedure. You will be able to take your usual medication with a small amount of water. If you have diabetes, do not take your insulin or diabetic pills until after the procedure.
- You will need a driver to return home.
- Do not take any aspirin or aspirin-containing medication at least eleven days before the procedure. They may prolong bleeding.
- Wear loose fitting clothing that is easy to take off and put on.
- Take a shower the morning of the procedure, using a bactericidal soap to reduce chances of infection.
- Do not wear jewelry.
Aftercare
Depending on the disease present and the surgery performed, mobility of the cervical spine may be limited after cervical spine surgery. Physical therapy is often indicated after surgery.
Complications
What might go wrong?
This procedure is considered minimally invasive and safe. However there are several complications that may occur during or after this procedure. No procedure is 100 percent foolproof. This document doesn’t provide a complete list of all the possible complications, but it does highlight some of the most common problems. Complications are uncommon, but you should know what to watch for it they occur.
Some of the most common complications following implantation of a spinal cord stimulator include :
- Infection
- Increased localized pain
- Paralysis or loss of movement
- Pneumothorax (collapsed lung)
- Spinal fluid leaks
- nerve damage
- allergic reaction
- symptoms worsen
- seroma (fluid around a surgery site)
- device failure
Infection :
Infection can occur at the incision, around the spinal cord, or the vertebra (bone).
Increased Pain :
Increased localized pain should be expected for one to two weeks following the surgery.
Paralysis :
Bleeding into the spinal canal can cause squeezing of the spinal cord. This can cause paralysis or loss of movement of the limbs. Loss of bowel and bladder function can also occur. This would require an emergency surgery. The spinal cord damage can be permanent. Bleeding is more common in patients taking blood thinners or who have a genetic problem with clotting.
Pneumothorax :
Pneumothorax is the collapse of a lung. A lung can be punctured when needles are inserted in the area of the chest or upper back.
Spinal Fluid Leaks :
Spinal fluid leaks out of the epidural space can cause a persistent headache. This is caused by leaking of the cerebral spinal fluid around the electrode wire site. Lie flat and drink plenty of caffeinated non-carbonated fluids. If your headache lasts longer than 48 hours, call your surgeon. A spinal fluid leak may require surgery to correct.
Nerve Damage :
Nerve damage caused by needles and electrodes placed in the area of the spinal cord may occur. Even paralysis that could be permanent could occur.
Allergic Reaction :
Allergic reactions can occur, usually to medications or dye used during the surgery. Anaphylactic reaction can be deadly.
Symptoms Worsen :
A worsening of symptoms can be a result of surgery.
Seroma :
Seroma is the collection of fluid around a surgery site. One can develop in the pocket around the implanted device. It can last several weeks or months. It can be drained by your surgeon. It can become infected. If this occurs the device must be removed.
Device Failure :
Technical problems or failure of the device can occur. Movement or disconnection of the electrode wires makes the device ineffective.
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