Spinal cord stimulation can be an effective alternative or adjunct treatment to other therapies to manage chronic back and/or leg pain and our Institute use Medtronic devices because offers a portfolio of spinal cord neurostimulators that deliver targeted chronic pain management.
Medtronic has been innovating in neurostimulator technology for more than 30 years. In that time, over 250,000 patients have benefited from spinal cord stimulation and provide clinicians and patients with reliable, best-in-class pain management systems and service.
A typical spinal cord stimulation system implant is completed in 2 stages. The first stage is a 3- to 7-day screening test to evaluate whether or not the patient is a candidate for the second stage – the spinal cord stimulation system implant.
During a neurostimulation screening test, the patient receives a temporary, external neurostimulation system for 3 to 7 days and percutaneous leads are used for the screening test.
During the screening test, the patient uses the external neurostimulation trialing system while completing daily activities. In some cases, the patient can use a patient control device to change some stimulation settings within physician-programmed limits.
Throughout the screening test, the external neurostimulator collects patient-use data and the patient records activities, neurostimulation settings, and degree of pain relief in a diary.
After the screening test ends, percutaneous trial leads are removed. Results are evaluated to determine if the patient is a candidate for a spinal cord stimulation system implant.
After the screening test, clinicians review input from the pain management team, the patient, and the patient’s family or caregivers; evaluate if the goals of a neurostimulation trial have been met; and determine if a neurostimulation system will be implanted.
Goals of the screening test:
- Stimulation covers the patient’s pain areas
- Patient is comfortable with the sensation of stimulation
- Patient experiences adequate pain relief (more than 50%)
- Patient experiences improved function
Implanting the spinal cord neurostimulation system requires a short surgery, typically done on as an outpatient procedure. The neurostimulator is inserted under the skin through a small incision in the upper buttock. The long-term lead is implanted in the epidural space of the spinal cord.
Indications for Neurostimulation
An implantable neurostimulation system is indicated for spinal cord stimulation (SCS) systems as an aid in the management of chronic, intractable pain of the trunk and/or limbs-including unilateral or bilateral pain associated with the following conditions:
- Failed Back Syndrome (FBS) or low back syndrome or failed back
- Radicular pain syndrome or radiculopathies resulting in pain secondary to FBS or herniated disk
- Postlaminectomy pain
- Multiple back operations
- Unsuccessful disk surgery
- Degenerative Disk Disease (DDD)/herniated disk pain refractory to conservative and surgical interventions
- Peripheral causalgia
- Epidural fibrosis
- Arachnoiditis or lumbar adhesive arachnoiditis
- Complex Regional Pain Syndrome (CRPS), Reflex Sympathetic Dystrophy (RSD), or causalgia
The Failed Back Surgery Syndrome (FBSS), it was defined by North & Campbell in 1991 as persistent or recurring low back pain with or without sciatica, following one or more lumbar spine operations.
Chronic debilitating low back pain occuring in a patient after back surgery of a variety of types, such as discectomy, laminectomy, and lumbosacral fusion, that was unsuccessful in relieving the patient’s symptoms. Nearly 300,000 spinal surgeries are performed in the United States each year. Approximately 85% of these procedures involve laminectomy and discectomy and 15% are spinal fusions.
FBSS is considered to be a severe, long-lasting, disabling and relative frequent (5-10%) complication of lumbosacral surgery and this is the most common indication for neurostimulation.
Patients with FBSS have failed to obtain long-term pain relief, even after treatment with a variety of therapies, including oral medication, nerve blocks, corticosteroids injection, physical therapy, chiropractic care, fixation surgeries and repeated surgeries:
Neurostimulation has been used for FBS since 1967 and Long-term follow-up studies have shown a success rate up to 75% for FBS at 5 years.
Neurostimulation can lower the medical costs of FBS over time, by reducing office and emergency department visits. Other benefits are:
- SCS pays for itself within 2.1 years.
- Medications tend to stabilize or decrease
- Activities of daily living increase
- Some patients are able to return to meaningful employment.
Complex Regional Pain Syndrome (CRPS)
CRPS I and II are chronic pain syndromes characterized by severe pain accompanied by autonomic changes in the painful region, including edema, temperature abnormalities, sudomotor activity and skin color changes. At this time CRPS affects up to 1.2 million US people.
CRPS develops in response to a traumatic physical event, such as an accident or medical procedure. Even “minor” accidents, such as a sprain, can be the cause of CRPS.
CRPS causes nerves to misfire, sending constant pain signals to the brain. Typically, patients with CRPS see an average of 5 doctors before being accurately diagnosed.
Retrospective reviews of a limited number of patients having Neurostimulation systems implanted for the management of CRPS have shown that patient satisfaction with this mode of therapy is quite high, with up to 90% finding the stimulator helpful for their pain.
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