Spinal Cord Stimulation Therapy

If back surgery fails to relieve your back pain, you may want to think about electoral stimulation of the spine.

Failed back surgery syndrome (FBSS) is defined as persistent or recurrent pain despite having had spinal surgery. The pain is most often in the lower back and/or legs. By some estimates, up to 40% of spinal surgeries result in FBSS.

You should discuss spinal cord stimulation (SCS) therapy with your doctor if you have continued, disabling, radiating pain following surgery for a herniated disc. You should also discuss SCS if you have chronic back pain for other reasons. It is a safer alternative than taking opioids to relieve back pain. And you won’t run the risk of overusing or becoming dependent on these powerful and highly addictive drugs.

  • This approach involves applying electrodes that emit pulses of electricity. These pulses go directly into spinal nerves.
  • The exact way in which this reduces pain is not entirely understood.
  • One theory is that the electrical pulses “hijack” the nerves and override the pain signals. This then interferes with the transmission of pain signals to the brain.
  • When the electrical pulses are switched on, the patient feels numbness or tingling in the affected areas. This is often preferable to the sensation of pain.

Candidates for spinal cord stimulation therapy generally undergo a trial period of about five to seven days. During this time, electrodes are temporarily inserted into the spine.

  • Local anesthesia is used so that the patient can remain awake to provide feedback as to the optimal placement of the electrodes.
  • The electrodes are then attached, via wires called “leads,” to an external pulse-generating device that’s worn outside the body.
  • If all works well during the trial period, a permanent implantable pulse generator (IPG) can then be installed.
  • It is often placed in the buttocks or lower abdominal region.
  • The installation is likely done using sedation or general anesthesia.

The IPG is then controlled remotely with a wireless external control unit. The patient can use the control unit to turn the IPG on or off, or to adjust the device’s intensity or other settings. The device is not intended to be used all the time. It is used for one or two hours at a time, three or four times a day. It needs to be turned off during takeoffs and landings when traveling by air. It should also be turned off before walking through anti-theft systems in retail stores. That is because these security systems are known to trigger unpleasant surprise jolts when the IPG is left on.

In clinical studies, spinal cord stimulation is helpful between 50% and 70% of the time. About one quarter of patients have complications.

Spinal cord stimulation complications include:

  • Gradual displacement (“migration”) of the electrodes
    • This can lead to further surgery to reposition the electrodes or replace the device.
  • Infection at the site of implantation

Some IPG units need to have their batteries replaced, usually after a few years.

In very rare cases, complications include:

  • Internal bleeding
    • This includes spinal epidural hematoma, or bleeding around the nerves of the spine.
  • Nerve damage
  • Paralysis
  • Death

Future shocks

Researchers are testing new ways to employ electricity to stimulate nerves and ease pain. Most of the SCS devices used today deliver low-frequency electrical pulses. But there’s growing interest in high-frequency SCS.

  • In some studies, high-frequency SCS appears to be more effective for low back pain.
    • This is compared to low-frequency stimulation.
  • Another new approach is designing devices that deliver short bursts of stimulation. This is rather than continuous electrical current.
    • Studies suggest that this approach may result in greater pain relief.

Technological advances may also improve the ability to place electrodes in the ideal location to stimulate nerves involved in pain. The goal is to deliver just the right amount of stimulation to the exact part of the nerve involved.

Is SCS an option for you?

The bottom line is that SCS can help some people when other treatments have failed. But not everyone benefits. And the risk of complications is a cause of concern. But let’s say you have chronic back pain that hasn’t been helped by other treatments, including surgery. It might be worth talking to your doctor about SCS.

In evaluating whether SCS is right for you, your doctor will take into account several critical health factors.

  • Let’s say you have a pacemaker. Your doctor will need to determine that the SCS device’s electrical signals don’t interfere.
  • What if you take anti-clotting (anticoagulant) medication? You will be at higher risk of bleeding at the site where the device is implanted.
    • Your medication regimen may need to be adjusted before and after surgery to prevent bleeding.
  • Your doctor will also review your history of back pain.
  • The longer someone has suffered from chronic back pain, the less likely SCS is to help.