SPINAL CORD STIMULATION
What is it?
A spinal cord stimulator (SCS) or neurostimulator is a surgically implanted device used to block out pain in the neck, back or limbs. When turned on, the spinal cord stimulator stimulates the nerves in your back that correlate to the area where your pain is felt. Pain is reduced because the electrical pulses modify and mask the pain signal from reaching your brain. Stimulation does not eliminate your pain but rather interferes with your nerve signal to the brain and changes the way the brain perceives it. Some devices use a low-frequency current causing a mild tingling feeling in place of pain called a paresthesia. Other SCS devices use a high-frequency current or burst pulses to replace your pain with no tingling feeling. Our clinic offers all of the leading SCS brands (Abbott, Boston Scientific, Medtronic, and Nevro) and your provider can help you determine the best device for you. A spinal cord stimulator trial is performed to determine the effectiveness of the treatment prior to implantation.
What is required to try the device?
Prior to the trial, you will be required by your insurance company to complete Physical Therapy with in the last 12 months and a one-time psychological evaluation. A prior authorization is required by your insurance company prior to the trial. We will obtain this prior authorization for you.
Our clinic works with a third party to ensure that this procedure will be covered by your insurance. Once you have completed the psychological evaluation and physical therapy, our clinic will send the necessary records to the reimbursement department. The reimbursement department will contact your insurance company or refer to the coverage policies in order to reach a decision on coverage. Our clinic requires an approval from the reimbursement department before we can schedule a trial. You will also need to schedule a trial education appointment with your TCPC provider.
Who is a candidate for the SCS?
Patients who are candidates for a SCS have often tried and fail conservative therapies, would not benefit from additional surgery, or do not want to pursue surgery due to risks or long recovery. Patients who are recommended to try an SCS have usually had chronic debilitating pain for more than 3 months.
What can I expect during the trial?
The procedure is done by a physician under fluoroscopy (xray). You will be receiving sedation through an IV prior to the procedure. You will be brought into the procedure room and lay on your stomach on a special table. Your skin will be cleaned at the injection sites and a local anesthetic will be used to numb
your skin. Two temporary leads for the SCS will be placed using a small needle along the area of the spinal cord the correlates to your area of pain. Once the leads are placed they will be connected to an external battery and covered by a large bandage. You will get to go home and use the SCS in your daily life for one week. You will be instructed to avoid getting the bandages wet and you will only be allowed to sponge bathe. You will return to the clinic 2-3 days after your temporary leads have been placed to check your lead insertion site and fine tune stimulation. The representative from the device manufacturer and the nurse will be present for this appointment. You will return to the clinic one week following your lead placement for removal of the leads by a nurse. At this time you will discuss the amount of pain relief you received during the trial. If you decided to pursue an implanted system, we will submit to your insurance company for another prior authorization for the implant.
What can I expect during the implant surgery?
Prior to the implant surgery you will need to obtain a pre-operative history and physical evaluation. You will also need to have a implant education appointment with your TCPC provider. The surgery is performed by a physician under fluoroscopy (xray) at Twin Cities Surgery Center or Fairview Southdale Hospital. You will be receiving sedation through an IV prior to the procedure. You will be brought into the operating room and lay on your stomach on a special table. Your skin will be prepped and cleaned prior to any incisions being made. The permanent leads for the SCS will be placed using a small needle along the area of the spinal cord the correlates to your area of pain. Once the leads are placed they will be connected to an internally placed battery located most commonly in the upper buttock. The surgery is outpatient and you should plan on being at the Twin Cities Surgery Center or Hospital for 3-4 hours.
What can I expect after the surgery?
You will receive an antibiotic to prevent infection. There are certain activities that should be avoided for 6-8 weeks after the surgery to prevent movement of the implanted leads including bending at the waist, twisting, reaching overhead, and lifting more than 5 pounds. You will return to the clinic for a visit with a nurse who will look at your incision site 3-4 days after the surgery. At this time you will be cleared to shower. You will also meet with a representative from the device company who will turn the device on and program it.