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Spinal cord stimulation for pain

About spinal cord stimulation

Spinal cord stimulation therapy is used to relieve chronic limb or spine pain. Generally the procedure is considered when patients have failed to respond adequately to medical therapies and if they meet certain other criteria that lead us to think the procedure may be effective.

When used for spondylosis, the most common indication for spinal cord stimulation, 79% of 72 patients treated in our unit have achieved worthwhile lasting benefit in terms of pain relief. Other conditions that have been successfully treated include peripheral nerve injury, complex regional pain syndrome, phantom limb pain and ischaemic limb pain.

How does spinal cord stimulation work?

Pain signals are transmitted along sensory nerves up the spinal cord where they are perceived as such by certain areas in the brain. It has long been known that simultaneously activating non-pain sensory pathways may block the pain signals. Chronic electrical stimulation of the dorsal columns of the spinal cord via an electrode placed over the membrane ensheathing the cord stimulates these non-pain pathways to reduce pain perception. Instead, the patient feels a not unpleasant tingling in the part of the body, usually an arm or leg or the spine, from which the non-pain signals travel. The location of the electrode is adjusted to stimulate the particular spinal cord pathways corresponding to the body location where the pain is perceived.

Procedures and equipment involved in spinal cord stimulation

Implantation of dorsal column spinal cord stimulators takes place in two stages.

First, the stimulating electrode is inserted to lie over the rear of the spinal cord sitting on the dura, the membrane that ensheaths the cord. A small space must be made (laminotomy) in the side of the one of the vertebrae about half way up the spine to allow access to the spinal cord. (If the desired area of stimulation is in the hand or arm as opposed to the lower back or legs, the electrode is placed in the neck rather than lower down in the spine). Leads are tunnelled under the skin from the electrode to a point on the surface of the body.

If useful stimulation can be achieved, the second stage of the procedure involves connecting the leads under the skin to a permanent battery control box like a heart pacemaker also placed in a convenient location under the skin, usually over the abdomen to one side. Now the patient has no leads connecting to the surface and is able to control the strength of stimulation using a personal remote control device.

Follow-up after the spinal cord stimulation procedure

Following the procedure, the patient is assessed in the neurostimulator clinic, where further optimisation of the stimulator settings is performed. The goal is to achieve maximal pain relieving stimulation of the affected site, while minimising stimulation of other parts of the body.

The stimulator battery normally lasts several years. When the battery does eventually fail, it can relatively easily be replaced as a day-case procedure under local anaesthetic.