Spinal Cord Stimulation

A spinal cord stimulator (SCS) is a device that sends a mild electric current to the spinal cord and masks the pain signal from reaching the brain. This may be considered as an option for pain relief in patients with localized, refractory and persistent pain (>6 months). Patients may profit from an SCS if they have one of the following conditions:

  • Failed Back Surgery Syndrome (FBSS)
  • Posttraumatic Neuralgia
  • Incomplete Plexus lesions
  • Postherpetic neuralgia
  • Neuralgia in severe Peripheral artery disease (Fontaine classification stage IIb or III)
  • Neuralgia in Diabetic Polyneuropathy
  • Refractory Angina pectoris
  • Complex Regional Pain Syndrome (CRPS) Type I = Reflex Sympathetic Dystrophy
  • Complex Regional Pain Syndrome (CRPS) Type II = Causalgia

Procedures

Rod leads can be placed through a puncture, while flat electrodes need to be inserted via a minimally invasive surgical approach. These procedures are undertaken with the patient under slight sedation and local anesthetics.

For the implantation of a rod lead, a hollow needle is inserted through the skin into the epidural space of the spine with the help of X-ray fluoroscopy. Through this needle, a lead is inserted and positioned over the spinal cord. An intraoperative trial stimulation is undertaken to check whether the affected area is covered by the position of the lead. Then, the lead is connected to an external generator and the patient is discharged from hospital after receiving advice about the use of the external generator.

After a two weeks’ trial period, the effect of the stimulator is evaluated. If the patient is happy with the pain relief, another operation will be performed where the generator will be implanted permanently. The generator will need to be changed approximately every 9 years.

Subcutaneous Nerve Stimulation

Apart from a direct stimulation of the spinal cord, stimulation leads can also be directly applied to peripheral nerves in conditions like:

  • Chronic low back pain
  • Scar pain
  • Occipital neuralgia
  • Migraine