What is it?
A spinal cord stimulator is a specialized device, which stimulates nerves by tiny electrical impulses via small electrical wires placed in the epidural space just outside the spinal space. This device interrupts nerve conduction (such as conduction of pain signals) to the brain.
For the spinal cord stimulator trial: Using x-ray guidance, a needle is placed so that the stimulator electrodes may be guided into the appropriate position in the spinal canal. Once the electrodes are in place, you will be asked if you feel stimulation in the area of your pain to confirm adequate placement. If you do have pain coverage with the stimulation, the electrodes will then be secured to your skin to maintain proper positioning. A dressing will be applied to keep the electrodes clean, dry and protected during the trial period, which may last from 5-10 days. The electrodes are connected to an external battery that is programmed to match your specific pain.
For the spinal cord stimulator implantation: After it has been determined that the spinal cord stimulator is effective for managing your pain during the spinal cord stimulator trial you will be scheduled for implantation at a local hospital. This procedure is performed under general anesthesia, and you will be asleep during the surgery. Using X-ray guidance, a needle is placed so that the stimulator electrodes may be guided into the appropriate position in the spinal canal. Once the electrodes are in place, you will be woken up from anesthesia and asked if you feel stimulation in the area of your pain to confirm adequate placement. If you do have pain coverage with stimulation, you will be put back to sleep with general anesthesia and a 1-2 inch incision will be made in your lower back to secure the stimulator electrodes in place. This will be connected to a battery pack (stimulator generator) which is placed under the skin either in the left or right buttock, for which a 2-3 inch incision is made for adequate placement of this device.
What to expect
Initially this procedure is done on a trial basis, with a permanent implant put in if the outcome is positive. This outpatient procedure is generally performed under light sedation or occasionally general anesthesia. The stimulator is implanted under the skin of the abdomen and small, coated wires—called leads—are then inserted under the skin with a needle to the point they are inserted in the spinal canal. When the leads are in the optimum location, they are connected to a portable, external generator.
During the trial, the patient will take notes to track how well the stimulator handles the pain. If the trial is successful, a permanent implant procedure is scheduled. The permanent implantation requires a relatively short surgical procedure, about 1 to 2 hours, under light sedation or general anesthesia. The generator will be placed in the area of the body that the patient and the doctor have agreed upon. Leads will be placed along the spinal cord and attached to a generator and bandages will be applied over the implant.
How to prepare
It is recommended that patients on a blood thinner, like aspirin, stop at least a week before the procedure. The patient’s ability to clot blood will also be checked prior to the procedure to prevent excessive bleeding. Patients will be expected to not eat and limit drink to clear liquids for at least six hours before the procedure. Loose clothing is recommended for ease of dressing after the procedure, and arrangements should be made for a ride home.
How long will it take?
The procedure itself takes approximately 1-2 hours, and you may be observed for 30-60 minutes after the procedure.
After the procedure
Most often you can go home in about 60 minutes after the procedure. Written instructions will be sent home with you. You will need someone to drive you home and care for you for the first few hours after the procedure.
What to expect the day of your procedure
You are expected to arrive at the surgery center at least one hour before your procedure is scheduled. Bring a responsible adult driver with you because you may be receiving medications that could impair your ability to drive. Unless you are certain you will not be receiving sedation, do not eat anything for 6 hours prior to your procedure; you may have modest amounts of clear liquids (liquids you can see through) up to 4 hours beforehand. Please take your regularly scheduled blood pressure and heart medications with a sip of water as you normally would. If you have diabetes, take half of your normal dosage and bring your insulin with you.
After you arrive, you will be asked to sign-in and complete any paperwork as needed. You will then be taken to the preoperative area. At this time, a nurse will ask you some medical questions and have you sign your consent forms. It is imperative that you, the patient, inform the assistant of any changes in your history and/or physical, such as recent flu or any health problems that might affect your procedure. Inform the staff of any allergies, especially to Betadine or Iodine.
You will be asked to change into a gown. An assistant will take your blood pressure, heart rate, temperature, and oxygen saturation. An IV may be ordered by your physician in order to provide pain relief and relaxation.
The anesthesiologist, physician, or nurse will talk to you before your procedure. You will then be positioned and the injection site will be cleaned. The pain management physician will perform the procedure. You may be administered medication before and/or during your procedure to help you relax and provide pain relief. You may doze off during this time. Afterward, the cleaning solution will be washed off and bandages will be applied as needed.
You will be transported to the recovery room area where you will be monitored anywhere from 20 minutes to an hour. You will be offered beverages and some crackers. After this, someone will take out your IV and help you get dressed if needed. Lastly, your caregiver will be given discharge instructions for your care at home.