How is a spinal cord stimulator inserted to treat chronic pain?

For those who suffer with chronic back, leg or arm pain, spinal cord stimulation is a therapy that blocks pain signals before they reach the brain. The small device is implanted under the skin, very near the spine. As with any surgical procedure, a patient wants to know just what to expect exactly and the risks involved following the operation.

Mr Richard Gullan is a leading neurosurgeon at the London Neurosurgery Partnership, who is highly experienced in performing the procedure. Here he explains how the device is inserted and what the possible complications could be…
 

What happens during the operation?

First of all, there will be a trial for the spinal cord stimulator to see if it will actually reduce the pain but also to determine if the patient is still ok to go ahead after the trial. During the surgery, the patient will be under sedation and will lie on their stomach. X-ray is used to locate the area and electrode wires are inserted into the lower spine, as the generator will sit near the buttock.

A test stimulation will be performed during surgery which the patient has to be awake for. This is to determine if it is working and to help the surgeon change the settings or to reposition the device if necessary. Once this has been established the patient will again be sedated and the generator will be implanted into the buttock. A lead wire will run from the generator and attached to the electrode wire. Once all is in place, sutures are used to close the skin and the patient will be taken to the ward to recover.
 

What are the risks of spinal cord stimulation after the procedure?

There will be restrictions in place during recovery and the surgeon will talk you through those. Mostly it is about looking after yourself and the wound sites, so no strenuous activities or bending and twisting until it is all healed. It is also recommended not to smoke or intake nicotine products as they prevent healing. Some of the risks do include:
 

• Epidural haemorrhage, hematoma, infection, spinal cord compression
• Battery failure and/or battery leakage
• Cerebrospinal fluid leak
• Persistent pain at the electrode or stimulator site
• Lead migration, which can result in changes in stimulation and reduction in pain relief
• Generator migration
• Paralysis, weakness, clumsiness, numbness, or pain below the level of implantation
   

The patient will be sent home with instructions on how to use the stimulator but of course, everything will have already been explained to them. The consultant will provide follow-up and check-up consultations to see how the patient is getting on.