What is Spinal Cord Stimulation (SCS)?

SCS is a therapy that uses electrical impulses to block pain from being perceived in the brain. Instead of pain, the patient feels a more pleasant tingling sensation.

Who is a good candidate for a Spinal Cord Stimulator?

We will generally consider the following:

• Treatment is most effective when pain is in one or both arms or leg (radicular pain), or for low back pain that persists after surgery (failed back surgery syndrome).

• Conservative treatments have been tried and failed.

• Further surgery is not likely to help.

• No untreated drug addictions.

• Cleared by psychological evaluation.

• The patient does not have a pacemaker or other contraindications.

• The patient has had a successful SCS trial.

• The patient is willing to play an active role in establishing and maintaining increased quality of life.

• Cessation of cigarette smoking 3 moths prior to the procedure.

• Not on long term antibiotics for other medical reasons.

• Will not need MRI studies for ongoing medical problems in future.

The Trial

After your consultation with Dr. Thiyaga to discuss about the SCS and your consent that you would like to proceed, a trial will be arranged to learn if the SCS will be effective in treating your pain. The trial involves a surgical procedure to implant a temporary stimulator over the spinal cord to determine if the area of your pain will be blocked by stimulation. The trial may last a minimum of 24 hours or as long as 1 week. We want to be sure that you have satisfactory pain control and that you are comfortable with the sensations of stimulation. If the trial is successful, the permanent stimulator implantation will be scheduled.

Implantation: The Surgical Procedure

The procedure will take place in a sterile environment or in the operating room. You will be given a local anesthetic so that you can be awake during the procedure (with minimal discomfort) in order to give feedback to the physician regarding effective lead placement.

After the local anesthetic has time to numb the area where the lead will be placed, the lead is inserted on the surface of your spinal cord through a needle or through an incision. Once the lead is in place, your physician will activate the system. You will help the physician determine how well the stimulation pattern covers your pain pattern. You will also get a sense of how stimulation feels to help determine if it is right for you

Risks of Surgery:

Any time surgery is performed there are possible complications. These include:

• Infection

• Bleeding

• Headache

• Paralysis

• Allergic Reaction

• Pneumothroax

• Spinal Fluid Leakage

• Death

Risks specific to the spinal cord stimulator:

• No stimulation or intermittent stimulation.

• Stimulation in the wrong location.

• Loss of pain relieving effect, with a return of your usual pain.

• The lead could move or break.

• There could be a poor connection between the lead and the battery.

Before Implantation

Specific instructions will be given by the person who schedules the procedure. Please review our standard pre-procedure instructions. We will provide audio-visual material to familiarize with the procedure.

After Implantation

As with any surgery, you will have some discomfort at the incision sites, and there will be some swelling which usually lasts for few days. There will be some discomfort over the area where the receiver is implanted. This is normal. Your doctor may prescribe an analgesic until this subsides.

Immediately following implantation, you should avoid lifting, bending, stretching, and twisting. Light exercise, such as walking is important to build strength and to help relieve pain.

Long Term Care

Leads can remain permanently in place. However, if you engage in extreme bending, stretching, twisting, or strenuous activity such as jumping exercises and diving, etc., the leads may move or become damaged and require surgical repositioning or removal. Moving or lifting heavy objects can move or break the leads. Sometimes leads will move as a result of normal bending, stretching, or twisting, or due to your unique physical structure. Check with your doctor before performing any strenuous activity.

Things to Keep in Mind:

Do not drive a motor vehicle or heavy equipment while using the stimulator. You may use it if you are a passenger.

The stimulator will set off metal detectors (such as at airports). You will want to be sure you have your SCS identification card in order to pass through.

Department store theft detectors may cause an increase or decrease in stimulation as you pass through. This is temporary and will not harm you or the stimulator, however, you may wish to turn the stimulator off before passing through.

Anything with magnets can affect your stimulator, in addition to theft detectors and metal detectors, be mindful of large stereo speakers with magnets, high voltage power lines, electric arc welding equipment, electric sub-stations and power generators. Magnets can turn an internally powered generator (IPG) on or off. You should avoid MRIs as they can damage the stimulator.

Normal household equipment will not harm or interfere with the stimulator. This includes cellular or portable phones, microwaves, computers, TVs, appliances, electric blankets, and heating pads.

The stimulator control magnet may cause damage to certain items or erase information on items with magnetic strips (bank or credit cards), Magnetic media (video cassette tapes, computer diskettes, cassette tapes), home electronic items (computer, VCR, television, camera). The magnet will stop watches and clocks, so you will want to store the magnet at least two inches away.

Life of batteries depends upon stimulation settings and usage. External batteries last anywhere from several hours to several days. When the battery of an implanted pulse generator is depleted, you may need surgery to replace the IPG. There are also rechargeable devises on the market.

Report to your doctor's nurse changes in stimulation patterns, increase in pain, or unexplained increased / decreased stimulation.

Will I be pain free?

There will be residual discomfort. Most patients report that 50%- 70% decrease in pain. The goal is to lower the level of pain and make it more manageable.

How will a spinal cord stimulator help me?

• Depending upon your work, you should be able to resume work at home or job that does not require strenuous physical activity.
  You can resume sexual activity.
  You can travel, keeping in mind that sitting for long periods of time is best avoided.

• You will be able to participate in recreational activities such as walking, fishing, and gardening.

• You will feel more in control of your attitude, and should notice a positive effect upon relationships.

Will my insurance cover the cost?

Most insurance plans including Medicare and workman's compensation cover the contracted portion of the cost. Please check with your health insurer for specific information, also please consult our billing department at 864 855 1633.

Please visit SCS manufacturer's website for additional product information:

ANS / St Jude Medical

Boston Scientific

Medtronic