Spinal Pain Management

Spinal Stimulator Placement

A spinal stimulator is a device used for the treatment of chronic spinal pain, which is unresponsive to medical or surgical therapy. One of the most common indications is failed back surgery. In failed back surgery, the patient’s pain returns or is not alleviated by surgery.

A spinal stimulator works by electrical stimulating sensory fibers in the back of the spinal cord. These fibers transmit the stimulus to the brain, which in turn sends inhibitory signals to the region of the spine receiving pain information from peripheral nerves. As a result, the overall sensation of pain is diminished.

Placement of a spinal stimulator involves a trial, and if successful, permanent implantation. In the trial, electrode leads are placed on the surface of the spinal cord via a small needle placed on the back. Using x-ray guidance, the electrodes are advanced to the desired position along the spine. The electrodes are then attached to a temporary generator, usually worn on a belt pouch. The procedure is performed under sedation and with local anesthetic. Once the stimulator is turned on, a patient will usually feel tingling in the region where pain relief is desired. If the trial results in significant pain relief, the stimulator is permanently implanted.

If the stimulator trial is successful, a stimulator is permanently implanted. This procedure is again performed under local anesthesia and sedation. Instead of exiting the skin, the electrodes are tunneled under the skin through a small incision in the back to a incision made near the flank. A pouch is created in that second incision. The generator is inserted into the pouch and the electrodes are attached to the generator. The incision is then closed with sutures.