Spinal Cord Stimulation and Treatments

A screening process is typically used to determine whether a patient is a good condition for this procedure. The first step is based on the patient’s medical condition and begins with a thorough assessment by a physician. Talk with your physician about next steps to be considered for spinal cord stimulation.

The success rate following a satisfactory trial is 80 percent to 90 percent. While there is a chance that it may fail, a worsening pain condition is often due to a new spinal problem that needs addressing. 

Ask your physician about the various companies to choose from. At Weill Cornell Medicine, our teams have had success with the Nevro system. Our experts have also successfully implanted devices from Medtronic, Abbott and Boston Scientific.

Your physician can guide you through the selection process as you consider several manufacturers.

Failed back surgery syndrome is one of the most common reasons spinal cord stimulation is used. This term describes chronic pain after one or more back or neck surgeries that have failed to alleviate persistent low back pain, leg pain sciatica (lumbar radiculopathy) or arm pain cervical radiculopathy.

As with any procedure, there is the risk of bleeding, infection or injury to the spinal cord. However, these are all extremely rare. There is a risk of device malfunction (<1 percent) or movement of the leads (13 percent risk) causing a lack of benefit.

The trial of the stimulator is simple and similar to an epidural injection. A physician will pass the wires through a needle and steer them to the appropriate area. This can be done relatively quickly, especially if it is done under light anesthesia.

While there are many similarities between the trial and the permanent implantation of a spinal cord stimulator, the main difference is the implantation of the generator. The technology used for spinal cord stimulation is evolving rapidly, but this is a typical process:

1. Local anesthesia is applied to the incision site, and you receive some sedation.
2. Your doctor inserts the needle into the epidural space, an area around the spinal canal, guided by an X-ray. The needle allows the doctor to pass leads with electrical contacts attached. A small incision may be needed to insert the needle.
3. If you end up having a paddle lead, part of the lamina, a small bone covering the back of the spinal cord, may be removed to allow room for placement of the permanent leads via the hollow needle.
4. The permanent leads are placed.
5. The leads are fixed in place, and you receive additional sedation.
6. A small incision is made where the generator will be placed.
7. The generator is implanted under the skin, usually in the abdomen, upper buttocks or chest. Generators range in size, with the largest ones about the size of a stopwatch. Comfort is a consideration in the generator’s location, and the doctor may ask you in advance about the best area. For instance, if you tend to sleep on your right side, you may prefer to have the generator on your left side.
8. Wires are tunneled from the leads to the generator and connected, enabling the current to flow when the controller is turned on later.
9.  

Recovery is brief. There are no incisions during the trial, so you experience soreness in your back for several days. With the permanent implant, you can expect to go home the same day as the procedure, and light activities can often be resumed after two to three weeks. Complete recovery may take six to eight weeks.

Certain physical activities will be limited for about three months to prevent the leads from moving. During this recovery phase, our teams recommend avoiding heavy exercise or any activity that applies torque to your back and could cause the wires to move. However, housework, walking and basic cardio exercises are acceptable.

The majority of improvement takes about five days during a trial. Therefore, we take about a week to test the relief. After a permanent implant, the recovery and improvement in pain can be slightly slower.

If your back changes with the standard rate of aging, this permanent stimulator should provide a lifetime of pain relief with periods of maintenance and battery revisions. However, it can be surgically removed if the device malfunctions or fails to give you relief.

A battery will generally last up to ten years if you choose a rechargeable battery, which must be charged daily for 30 to 45 minutes. It is a minor, 20-minute outpatient procedure performed under sedation to replace it.

If you prefer to reduce the hassle of recharging, you can opt for the implantation of a non-rechargeable battery (sometimes called primary cell or recharge-free), which lasts about five years.