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Studies in the past 35 years appear to indicate potential efficacy of the spinal cord stimulator in treating chronic pain disorders including Failed Back Syndrome , Complex Regional Pain Syndrome and Peripheral Neuropathy .


SURGICAL PROCEDURE


Complications are generally related to the surgical procedure and can include lead migration, Infection , Epidural Hematoma , Paralysis and in extremely rare cases, Death . The possibility of lead migration is lessened when placed by laminectomy.1

A trial is usually done before the permanent unit is placed. A temporary percutaneous lead is used, connected to an external pulse generator. The trial is from 3 to 7 days. If the patient has 50% to 70% pain relief in the trial, the patient is considered a candidate for the permanent unit.

Patients with SCS units are not able to have MRI procedures, and must avoid areas with high electrical fields, and take caution with anti-theft and metal detector gates. Patients are provided an ID card to allow bypassing airport security screening gates. Certain other medical procedures must be avoided.


TYPES OF EQUIPMENT


There are three types of SCS units:

  • Conventional Implantable Pulse Generator (IPG) consists of a battery and control electronics. When the battery wears out, it is surgically replaced. Battery life is generally 2 to 3 years, but can sometimes be much less.

  • Rechargeable Implantable Pulse Generator (IPG) consists of a rechargeable battery and control electronics. The battery is recharged by an external device worn for a few hours every two to three weeks. Eventually the IPG will need to be replaced, but far less frequently than a conventional IPG. One such device carries a 25 year warrantee in the European Union.

  • Radio Frequency (RF) device consists of an implanted receiver and a transmitter device worn like a cell phone. The transmitter sends RF energy to the receiver which in turn sends stimulation to the lead. RF units are generally used when a lower level of stimulation is needed.


The patient is provided a remote control to turn on and off the stimulator, and depending on the device and the surgeon's preference, allows for limited programming of the stimulation patterns. The surgeon has a programming device that provides a wide range of stimulation settings.


OTHER USES


SCS units have been used to treat patients with frequent Migraine s. The leads are implanted in the bilateral suboccipital region.2


REFERENCES



ADDITIONAL REFERENCES



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