Spinal Cord Stimulation (SCS)

 

Electrical stimulation often offers a solution in cases of chronic pain, with a strong neuropathic component. Chronic intractable, non-oncological pain is treated in the Twin institute with SCS via the pain treatment center in Nijmegen. This page is intended to give information about SCS as a form of pain treatment and its procedure.

What is SCS?

Spinal cord stimulation (SCS) is a treatment in which nerve pathways in the spinal cord are stimulated with small electrical pulses. To this end, an electrode is placed against the back side of the dura (epidural). The electrode is connected subcutaneously to a pulse generator, which provides the electrical power. The electrical pulses of the electrode block pain signals and prevent them from being perceived. The electrical stimulation causes a tingling feeling in the painful areas. In the ideal situation these sensations will cover the painful areas completely. If the patient is a candidate for SCS he or she will be referred to the anesthesiologist or the neurosurgeon for a consult. In this phase the severity, type and character of the pain are examined in order to see whether the patient is suitable for SCS. Then extensive information about the treatment will be given to the patient. The operation is performed in two steps: the test stimulation, possibly followed by implantation of the permanent system. That’s why the treatment consists of several phases. These are: the test phase, implantation phase and the control phase.

Test phase: During the test stimulation, the doctor will examine the reaction to SCS during several days or weeks. The reasons for this are:

  • The opportunity to get acquainted with handling of the system,
  • Determine whether the pain is relieved,
  • Determine to what extent the pain is relieved,
  • Evaluate whether the treatment relieves enough pain to consider implantation.

The test phase starts with the implantation of the electrode. This is a surgical procedure performed under local anesthesia, possibly with a sedative, and antibiotics to prevent infections. The epidural space is located with a special hollow needle. The complete procedure take 1.5 to 2 hours. This is usually done in a short hospitalization of one day. The patient is positioned on his stomach (in exceptional cases on his or her side) with pillows under head and chest during the procedure. The anesthesia is local, in order for the patient to be able to answer questions about the place and intensity of the stimulated region. This continues until the optimal stimulation is reached, where the painful area is covered by the tingling sensation. Subsequently, the electrode is fixated and its wire is guided out at the side of the body. Then the electrode is connected to an external ‘screener’, which temporarily serves as a pulse generator. During the test phase the optimal stimulation settings are explored with this screener.

Implantation phase: an appointment will be made with the doctor for permanent implantation of the system when sufficient pain relief is reached. A new pulse generator is placed inside the body during the implantation. In the case where a test electrode is used for the screening, the electrode will be replaced by a permanent one. The electrode is then connected to the pulse generator with an extension cable if needed. The pulse generator is placed under the skin on the side or next to the umbilicus (navel). The implantation is performed under general anesthesia in most cases, but sometimes local anesthesia is preferred.

Control phase: The adjustment of stimulation parameters starts the day after the implantation in most cases. Regular check-ups in the outpatient clinic follow after release from the hospital, in order to further adjust stimulation parameters for optimal stimulation effects. The patient receives a handheld device after the implantation. This allows the patient to turn the stimulation on and off and to increase or decrease stimulation strength within set limits.

Who is SCS for?

The best neuromodulation results using SCS are obtained with the following disorders:

  • Failed Back Surgery Syndrome,
  • Complex Regional Pain Syndrome I (Sudeck's dystrophy)
  • Peripheral nerve injury or sometimes spinal cord injury.

Suitable patients are usually over 18 years old and have suffered severe chronic pain for at least one year.

Results

The effectiveness of SCS varies. The possible long term effects are strongly dependent on the (neurological) cause of the pain. An assessment of individual chances at pain reduction will be made and discussed during the intake.

Risks and adverse events

SCS involves minor surgery, but as with every operation there are some risks. These are:

  • Bleeding, at the site of the punction or along the tract of the electrode under the skin,
  • Infections, if these occur they are mostly local, severe infections in the spinal cord area are rare,
  • Headaches
  • Technical problems with the equipment or disconnections in the lead,
  • Allergic reactions,
  • Insufficient or complete lack of pain relieve,
  • Spinal cord injury.   

opent in een nieuw venster Here you can see a patient information video about spinal cord stimulation (dutch). Scroll down to bottom of the page.  

 

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