Spinal Cord Stimulator Trial
This procedure has been around for many years. By implanting an electrode in the lower thoracic spinal cord area pain signals coming below that area is interfered with and patient gets significant relief of the intractable leg pain and at times low back pain that they have experienced chronically. This is the last resort surgery and all other options such as physical therapy, medications, and lumbar spine surgery should have been tried and have been unsuccessful in relieving patient's symptoms. If there is surgically treatable pathology such as spinal stenosis or herniated disc or compression fractures this procedure will not work. Also leg pains are in general more responsive to the treatment as opposed to mostly low back pains.
Trial stimulation is 1st tried using electrodes inserted via a needle under sedation. Trial stimulation procedure usually lasts less than one hour. Patients are sent home a few hours after the procedure. Patients are then sent home for a week with the wire connected to spinal cord stimulation generator. If excellent pain relief of greater than 80% of patient's pain is achieved then they are brought back for implantation of the permanent electrode and permanent generator. The permanent electrode is inserted via thoracic laminectomy under heavy IV sedation. The electrode is typically inserted at T7 to T9 levels. Patient is shortly awakened during the procedure so that they can tell whether the permanent paddle electrode is covering their typical area of the pain. If so the permanent electrode is sutured down to the bone so that it will not move and also the permanent generator is inserted typically in the buttock area just below the belt line. The permanent spinal cord stimulator surgery usually lasts one hour.
The complications of the permanent spinal cord stimulator insertion includes very small risk of neurological injury, very small risk of infection, and risk of electrode migration leading to loss of adequate pain control coverage that was achieved during the surgery. The procedure is in general very well tolerated and patient is sent home after overnight stay.