Spinal Cord Stimulator Trials and Implants
Why is this procedure done?
Spinal cord stimulation is an advanced technique used to treat refractory and chronic pain conditions such as pain following spinal surgery, complex regional pain syndrome or pain originating in the spine that is not amenable to neurosurgical options. It is typically considered after patients have exhausted other more conservative options such as therapy, injections and medications.
How is the procedure done?
Spinal cord stimulation involves the placement of a lead or wire containing electrodes into the epidural space via an epidural needle and then directing the lead to lie over the spinal cord. Electrical signals stimulate the spinal cord and relieve pain. The system is trialed by placing the leads temporarily to assess the response to the therapy. A trial typically lasts 5 – 10 days. The leads are removed and discarded at the end of the trial.
If sufficient pain relief is achieved during the trial, a surgical and permanent implant of the system will be scheduled. The surgical placement is an outpatient procedure lasting approximately an hour. It involves replacement of the spinal cord stimulating leads and a battery (implantable pulse generator) underneath the skin, similar to how a cardiac pacemaker is implanted.
What are my risks? What are common complications?
Spinal cord stimulation is extremely safe. However, all procedures have the possibility of complications such as bleeding, bruising, infection and damage to an unintended structure. Another risk of spinal cord stimulation is a failure to improve, as there is no guarantee that your pain will be relieved. Rarely, it may temporarily increase your pain.
What do I need to know before the procedure?
Ensure you know the location where you are to have your procedure. We have a procedure suite on the second floor of our Carmel office location as well as our Avon and Greenwood office locations, but we also perform procedures in a few ambulatory surgery centers in the Indianapolis area. Trials may sometimes be performed in our office locations, but permanently implanted systems are done in the operating room of an ambulatory surgery center or hospital.
You must bring a driver with you to the procedure. This person will need to be able to drive you home and give you some assistance following the procedure.
You may take your regularly prescribed medications such as blood pressure, heart, diabetes and pain medications the day of your procedure unless told otherwise.
If you take any blood thinners—for example Coumadin, aspirin, Plavix, Xeralto, Eliquis or Ticlid—make sure we are aware of this medication as soon as possible. You will be given specific instructions regarding any need to discontinue or modify your current use of any blood-thinning medication. If necessary, we will get clearance from your cardiologist or other physician to ensure that this medication change is safe and appropriate for you based on your heart history, including prior heart attack, stent placement or open-heart surgery.
Be sure to make us aware if you have been started on an antibiotic for a bacterial infection prior to arriving for your injection. This may cause your injection to be delayed until you have cleared the infection.
You may shower/bathe before your procedure. We will provide you directions to shower with Hibiclens prior to a permanent spinal cord stimulator implant.
You may eat a light meal before your procedure unless you have been scheduled for IV sedation at one of our surgery center locations. If you are to have sedation, you should not eat or drink anything after midnight the night before your procedure. This includes water, coffee, chewing gum and hard candies.
General discharge instructions
Recovery after a trial spinal cord stimulator implant is brief and comparable to other interventional procedures such as an epidural steroid injection. However, you will have the temporary leads secured to your skin and bandaged to prevent movement and infection. Recovery after a permanent spinal cord stimulator can last up to six weeks with restrictions on movement and activity.
You could feel dizzy or unsteady when you stand up. This can be normal. Take your time by rising slowly from a seated or lying position.
You cannot shower/bathe following the placement of a trial lead for the duration of the trial. You will be told when it is safe to bathe after a permanent implant.
A follow-up appointment will be scheduled after your procedure. If you have any questions or concerns regarding your procedure, please do not hesitate to contact your physician’s office.
What should I expect while recovering?
During the trial of spinal cord stimulation, we will encourage you to live as normally as possible given the limitations of the temporarily secured leads. We want to assess how much functional improvement and improvement in pain you get from the use of spinal cord stimulation.
Recovery after a permanent spinal cord stimulator placement may take up to six weeks with restrictions on movements and activity. We will discuss the particulars of returning to work and activities during your follow-up appointments. This will vary depending on the physicality of your job.