New England Spine Care

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Definition and Description

 

Spinal cord stimulation (SCS) is a pain-relief technique that delivers a low-voltage electrical current continuously to the spinal cord to block the sensation of pain.

 

Chronic pain is ongoing or recurrent pain lasting longer than the time of normal healing for an illness or injury, (more than 3 to 6 months). Chronic pain can result from an injury; scarring in surgical area; surgery that may have caused nerve damage; spinal conditions such as degenerative disc disease; or other causes. If the chronic pain isn't responding to rehabilitation, injection treatments, other surgical options or medications (or patient cannot tolerate the side effects) , the pain physician may recommend neuromodulation through spinal cord stimulator as a way of treating the pain. This treatment may help manage the pain, restore function, decrease the need for oral pain medications, and improve one’s quality of life.

 

The first SCS was implanted in the 60’s for the purpose of managing pain. There are two types of stimulators, peripheral nerve stimulators and spinal cord stimulators. In either, a small pulse generator sends electrical pulses to the nerves (in peripheral nerve stimulation) or to the spinal cord (in spinal cord stimulation). These pulses interfere with the nerve impulses that make you feel pain.

 

The treatment is divided into two phases; a trial period (7 days) followed by the permanent implantation. The trial is done to see if it will help the pain. The pain physician will first insert a temporary electrode through a needle and place the electrode parallel to the nerves in the back. Then the electrode is connected to an external stimulator that the patient can control. The device is then programmed and the patient will go home for a trial run which will last 3-7 days. If the trial is successful, the doctor would recommend the permanent stimulator implantation which is a 75 minute minor surgical procedure. The permanent implant is similar to a pace maker and it is all internal and the functions and recharging is done through the skin.

 

Indications: Main indications are persistent pain after spinal surgery (Failed Back Syndrome, Post-laminectomy syndrome) and complex regional pain syndrome (CRPS, RSD) . Other indications include severe neuropathy, phantom leg pain and intractable angina. The list of indications is expanding as the technology improves.

 

Complications: Potential complications of the Trial include infection, spinal fluid leakage, bleeding, lead fracture and lead migration. Permanent implant complications can be related to anesthesia, surgery or the hardware. Complications can develop at the time of surgery or in the days, weeks or months following the surgery. A list of potential complications includes: infection, bleeding, blood clot, injury to blood vessels, nerves or spinal cord injury, poor wound healing. Hardware issues like lead migration, lead fracture, IPG failure may develop soon after surgery requiring a revision or removal.

 

Prepare for your Procedure

 

Certain medications have to be held before elective spinal procedures. A list of such medications is on the last few pages of this educational material. Do not hold such medication on your own. Ask your PCP /Cardiologist if it is safe to stop such medication before the procedure. Continue to take all other medications, especially your Blood Pressure and diabetes medications.

 

A sample of medications that must be held includes:

 

1. Aggrenox® (dipyridamole)

2. Aspirin

3. Coumadin® (warfarin)

4. Effient® (prasugrel)

5. Fragmin® (dalteparin)

6. Heparin

7. Eliquis ® (apixaban)

8. Lovenox® (enoxaparin)

9. Plavix® (clopidogrel),

10. Pradaxa® (dabigatran)

11. Ticlid® (ticlopidine)

12. Herbal blood-thinners NSAIDS (see sample below)

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NSAIDS to be held include Ibuprofen, Motrin, Naproxen, Advil, Nabumetone, Diclofenac, Etodolac, Indomethacin, Ketorolac, Meloxicam, Piroxicam, Ketoprofen, Oxaprozin, Aspirin).

 

Please let us know if you have had fevers, antibiotic treatment, any illness, or hospitalization within the last 4 weeks. You must be healthy and off all antibiotics on the day of the procedure.

 

Make sure you are not pregnant at the time of procedure. Do a Urine Pregnancy Test the night before your spinal injection and report the results to the nurse before the procedure. Exposure to X-ray (used during spinal procedure) is known to result in birth defects and possible miscarriage. If in doubt, cancel and reschedule your procedure until you can confirm that you are not pregnant.

 

Day of your Trial

 

• Arrive 30 minutes early and come with someone that can give you a ride home. Your procedure should take less than 120 minutes. Without a ride, the procedure will be cancelled.

• Do not eat or drink for 2 hours before your appointment. Diabetics may have a light meal.

• Please take a shower, wash the skin with normal soap. No lotion or creams on skin

• Wear dark, loose clothing and undergarment.

• Bring an updated list of your medications and allergies. Please point out if you are allergic to Contrast, Iodine or Latex.

• Bring your latest MRI /CT /imaging studies and the report with you.

• After check-in, an ID wristband containing your name and allergies will be placed on your wrist. A nurse or medical assistant will go over your meds and allergies and ask a few screening questions. Then a nurse will go over final preparation before the procedure. An IV line will be placed .

• In rare cases, oral sedation is needed to reduce anxiety associated with the procedure. This will slow down the entire process. Take medication 1 hour before the procedure.

 

During the Trial

 

• You will change into a gown. You will be escorted to the procedure by a nurse and a consent form will be reviewed/ signed before the procedure. You will be asked to lay on your stomach.

• Blood pressure and heart rate monitor will be placed on your arm/finger. Every piece of medical equipment produces loud noises (beeping, alarms) and you should not be concerned.

• Intermittently your doctor will talk to staff in the procedure room and instruct them to perform a task. Your physician will guide you step by step through the procedure.

• After standard time out, your skin will be disinfected with a cool solution, and sterile sheet of paper or plastic will be placed on your skin. A long drape may be placed that cover your entire back .

• When your physician is ready, X-ray unit is placed over your spine to identify the needle entry.

• Skin will be marked and anesthetized (you will feel small pinch and burning sensation ). It is normal to feel pressure or muscles twitching as needles is moved .

• A small catheter is guided through the needle and will be placed parallel to the nerves in your back.

• Sometimes patients feel tingling or pressure as the catheter is moved to final target. You may also feel transient pressure in your spine or down the legs.

• Once the catheter is in place, the stimulator may be turned on to assist final positioning. You will feel vibration or tingling in the areas you usually have pain.

• Once the pain physician is satisfied with final position of the lead, the needle is removed, the catheter is taped to your skin and bandage is applied . You are then transferred back to the recovery area for observation and device programing.

 

Right after the Procedure

 

• You will be observed for 45 minutes.

• The stimulator will be programed before you leave .

• If you have an IV line, it will be removed.

• A nurse will check your vitals and review the discharge instructions with you and will answer any questions you may have. A responsible adult must be present to drive you home after discharge.

• You will leave with a pain log and a copy of the discharge instruction which contains Emergency contact numbers. Please do not discard your discharge instructions or pain log.

• A responsible adult must drive you home.

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Discharge Instructions

 

• Make a follow-up appointment 1week after the procedure to remove the lead. Bring the pain log with you.

• The stimulator should stay connected for the duration of trial but you are able to turn it off if needed.

• Always Keep stimulator battery in the pouch provided.

• Do not remove bandage. If there is a discharge or any fluid leakage, call your doctor immediately.

• Sponge bath only for the duration of the trial. Don’t sponge bath over the wires.

• Do not submerge the unit under the water for the duration of trial.

• For 24 hours after the procedure, do not drive or operate machinery o If sedated, for 24 hours after the procedure, do not make financial or important life decisions until the effect of such medication is cleared.

• Stay active during the trial and determine how helpful the stimulator is in helping you pain.

• Call us if you have infection sign like fever, local warmth, discharge or collection of puss at the site of injection.

• You may resume your normal diet and medications after procedure.

• Ask your doctor how to resume blood thinners.

 

Call your doctor if you develop these symptoms. YOU MAY BE DIRECTED TO THE ER, if you experience:

 

• Shortness of breath or palpitations after procedure

• Sudden weakness

• Electrical shocks sensation. Turn unit off first.

• Fever over 101°F .

• Persistent redness, increased localized pain or discharge from the site of injection.

• Rash, hives or any other allergic reaction within trial period

• Intractable headache

• Significant increased pain not responding to ice, NSAIDS and pain meds or associated with fever

• Newly developed weakness in the legs, face or arm following procedure

• Newly developed incontinence of urine or stool following procedure