Spinal cord stimulation is a procedural treatment that can help with various pain conditions.
The procedure involves inserting flexible electrodes through a needle into the epidural space of the spine. The leads are secured to the skin where they exit with some adhesive dressings and a suture. Improvements in pain are measured over the following 7-14 days. The leads are attached to a small device known as a pulse generator for the duration of the trial. The pulse generator sends electric currents through the leads, which we hope will result in useful improvements in pain. The pulse generator is carried by the patient during the trial.
Placement of the trial spinal cord stimulation leads is a day surgery procedure, which takes about 30 minutes. Sedation is provided for the procedure. Whilst complications are unlikely the following problems can occur.
- Local pain is normal for 24-48 hours after the procedure. Pain occurs where the needle has been inserted through the skin and into the epidural space.
- Itching and skin reactions from the antiseptic and the adhesive dressing can occur.
- During the trial the epidural leads can migrate. Normally this problem can be adjusted for by changing the programming of the trial system. Occasionally trial needs to be reinserted on another occasion, as a result of lead shift but this is uncommon.
- Anaesthesia complications can occur during the procedure. You should not drive operate machinery or make important decisions for 24 hours after your anaesthesia.
- Infection can occur when trial spinal cord stimulation leads are placed. When infection occurs it is normally confined to the skin and easily treated. In our clinic the rate of infection during trial spinal cord stimulation is about 1 in 100. In very rare circumstances infection can follow the spinal cord stimulation leads into the spine itself. Infection in this location can be life threatening and potentially damage the spinal cord.
- Whenever an epidural lead is placed in the spine, a dural puncture headache can occur. A dural puncture refers to the epidural needle unintentionally entering the fluid that surrounds the spinal cord and leaking out. This creates a headache. The headache may need to be treated by injecting blood into the epidural space. This procedure is known as an epidural blood patch and it is generally effective in reducing the headache symptoms associated with dural puncture headache. Dural puncture is said to occur in roughly 1 in 200 epidural needle insertions. In our clinic we have not seen a dural puncture headache associated with spinal cord stimulator lead insertion.
- In rare situations allergic reaction can take place to the implanted leads.
Very Rare Complications
- Damage to the spinal cord and spinal nerves. In very circumstances damage to the spinal cord and nerves can occur. This can result form direct trauma from the epidural needles or the leads. It can result from bleeding in the epidural space. It can also result from infection.
- Spinal infection. It is possible for an infection to develop in the spine. In addition to damaging the spinal cord this can also result in widespread infection known as sepsis, which can be life threatening.
There are certain medical conditions that may cast spinal cord stimulation unsafe. If you have any of these conditions you should inform your pain management specialist. These conditions include problems with blood clotting, low platelet levels, infection, problem with the immune system and medications that artificially thin the blood.
If you have any further questions about spinal cord stimulation then please contact your pain management doctor prior to your procedure.
Trialling the device:
During the trial our team and the programmers from the device company will be in regular contact. You will be taught how to switch between programs and change power levels – until good reductions in pain are achieved.
If you are not achieving good reductions in pain – then we will obtain an X-Ray to confirm that the leads haven’t shifted within the spine.
After 7-14 days the trial will end and we will collect the results.
Problems during the trial:
If you experience any problems during the trial please get in touch with the NIPM team or the device company representative.
If you experience any severe pain, new leg or arm weakness or numbness, fevers, chills, severe headaches, bleeding /discharge from the wounds, or if you have any other concerns then please contact NIPM or the Day Hospital centre. If for some reason it is not possible to get in touch, please see your GP or attend your local emergency department for assessment.