Ongoing Back Pain?
A ‘Stimulating’ Approach

If surgery can’t eliminate your back pain, spinal cord stimulation very well might.

Dr. Sharan sits by the beside of a patient

Patients whose back and neck pain have not been relieved by spine surgery may find relief with spinal cord stimulation (SCS).

Spinal cord stimulators are implanted medical devices that send mild electrical pulses to an area on the spinal cord. These pulses disrupt many of the pain signals traveling between the spinal cord and the brain, offering patients effective pain relief and improved function.

Jefferson Health is a pioneer in SCS, with more than 5,000 procedures performed since 1986.  Around 70 percent of these implants have provided at least partial relief, in combination with medication, according to neurosurgeon Ashwini Sharan. Dr. Sharan has been performing the procedure for more than 20 years, with some of his patients experiencing total relief without medication, he notes.

Patients who still have persistent, non-mechanical back or neck pain after spine surgery – that is, pain due to tumors, inflammatory conditions and infections, rather than physical causes like strains and herniated discs – are absolutely great candidates.

Part One: Trial Stimulation

Dr. Sharan performs minimally invasive spinal cord stimulation in two phases. Phase one starts with a one-hour outpatient procedure, where real-time X-ray guidance helps him direct a hollow needle into a patient’s epidural space above the spinal canal. Through this passageway, he threads one or more thin leads, each carrying a number of small electrical contacts along the end.

Dr. Sharan then attaches the leads to a temporary battery, called an external pulse generator that delivers a mild current, or stimulation.

“We have many stimulator device options available that allow us to choose the right one for each patient’s particular needs,” says Dr. Sharan.  Then, with feedback from the patient during surgery (who is gently woken if asleep), Dr. Sharan adjusts the position of the electrodes until the area of pain feels covered by a tingling sensation. Once the position is chosen, he secures the lead in place.

The patient then spends anywhere from a few days to a few weeks at home with an external pulse generator that is carried on a belt or in a pocket. Dr. Sharan says longer trial periods give patients the chance to be sure they are benefitting from the stimulation.

When the patient returns for a  follow up, the leads are removed in the doctor’s office, and together, Dr. Sharan and his patient decide, based on the results of the trial, if spinal cord stimulation is the right treatment.

Part Two: The Implant

In phase two, Dr. Sharan again positions the leads.  This time, a different battery, called an impulse generator (IPG) is placed in either the patient’s buttock, flank (where it is protected by a layer of fat) or the belly area. The IPG contains a rechargeable battery, microprocessor and feed-through connections all sealed within a titanium cover. Multiple companies manufacture these devices and Jefferson physicians have access to a variety of implants.

“Since SCS began, rechargeable batteries have steadily become smaller, more comfortable and longer lasting, some as long as 20 years,” says Dr. Sharan.

Still a Last Resort

Between 50,000 to 60,000 spinal cord stimulators are implanted annually in the U.S. Despite all of the successful cases in more than 30 years, however, some patients approach it with reluctance. “Some people are uncomfortable with the idea of having hardware underneath their skin, though it’s really no different than a pacemaker is in heart patients.

“Spinal cord stimulation used to be considered a last resort,” notes Dr. Sharan. “It is true that some downsides still remain. For example, sometimes the leads shift overtime or batteries die unexpectedly. However, the opioid epidemic has shown us that people with chronic pain need safe, effective pain therapies. For the right candidate, spinal cord stimulation is definitely an option to consider that is far less invasive and safer than long-term opioid therapy.”

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