Background Information:

What are the other Names for the Procedure?

• SCS (Spinal Cord Stimulation)
• Spinal Cord Neuromodulation

What is the Spinal Cord Stimulation surgical procedure?

Spinal Cord Stimulation procedure involves placing electrodes in the spine for the delivery of small electrical impulses to the nerves, thereby blocking the pain signals and providing symptomatic relief.

What part of the Body does the Procedure involve?

Spinal Cord Stimulation involves the spine and tissue under the skin of the belly or buttock.

Why is the Spinal Cord Stimulation surgical procedure Performed?

The Spinal Cord Stimulation procedure is performed to provide relief from chronic pain in situations such as:

• Long-standing back pain not responding to medication or other surgery
• Complex regional pain syndrome
• Nerve relation pain in the legs or arms

What are some Alternative Choices for the Procedure?

Medication to control pain and alternative kinds of therapy, such as acupuncture, may be used to relieve pain.

What are the Recent Advances in the Procedure?

There are no recent advances in the procedure.

What is the Cost of performing the Spinal Cord Stimulation surgical procedure?

The cost of Spinal Cord Stimulation procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding a Spinal Cord Stimulation procedure and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.nlm.nih.gov/medlineplus/ency/article/007560.htm (accessed on 05/13/2015)

Prior to Spinal Cord Stimulation surgical procedure:

How is the Spinal Cord Stimulation surgical procedure Performed?

The Spinal Cord Stimulation procedure is performed in two stages.

• The surgeon first does a trial electrode placement to check for benefit with Spinal Cord Stimulation. This is done under local anesthesia
• The surgeon places electrodes under the skin leading up to the space surrounding the spinal cord. This is connected to an external stimulator that can be adjusted
• If the trial electrode and stimulator provide pain relief, the surgeon implants a stimulator under the skin of the belly or upper buttock and connects the leads to the electrode in the spine. This may be done under general anesthesia

Where is the Procedure Performed?

A Spinal Cord Stimulation is performed in a hospital, usually on an outpatient basis.

Who Performs the Procedure?

The Spinal Cord Stimulation procedure is performed by any of these medical personnel, with or without assistance from an anesthesiologist:

• A neurosurgeon

How long will the Procedure take?

The procedure may take an hour or two to perform.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Spinal Cord Stimulation procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are currently being taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For individuals suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Spinal Cord Stimulation procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Spinal Cord Stimulation surgical procedure?

Before a Spinal Cord Stimulation, the patient has to undergo certain tests such as:

• Chest X-ray
• EKG
• Routine blood and urine analysis

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is Spinal Cord Stimulation procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required after the procedure?
• What are the costs involved?

During the Spinal Cord Stimulation surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Local anesthesia by injection may be used while making a skin incision during electrode implantation. General anesthesia by injection and inhalation is administered during implantation of the stimulator.

How much Blood will you lose, during the Procedure?

Very minimal blood loss during an uncomplicated Spinal Cord Stimulation procedure may be expected.

What are the possible Risks and Complications during the Spinal Cord Stimulation surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
• Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders and chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Spinal Cord Stimulation surgery are:

• Excessive bleeding
• Infection within the surgical wound
• Anesthetic complications
• Injury to adjoining tissues
• Leakage of cerebrospinal fluid

What Post-Operative Care is needed at the Healthcare Facility after the Spinal Cord Stimulation surgical procedure?

• After the Spinal Cord Stimulation procedure, the patients are sent to an area of the hospital called the postoperative recovery area (or PACU)
• The patient’s blood pressure, heart rate, and respiration cycle shall be closely monitored. Any additional pain associated with the procedure will be treated
• Individuals are usually discharged from the hospital on the same day or after an overnight stay if there are no complications

After the Spinal Cord Stimulation surgical procedure:

What are the possible Risks and Complications after the Spinal Cord Stimulation surgical procedure?

The possible risks and complications that may arise after a Spinal Cord Stimulation procedure are:

• Excessive bleeding
• Infection within surgical wound

What is the Prognosis after the Surgery?

The prognosis after a Spinal Cord Stimulation procedure depends on the proper selection of patient and proper positioning of the electrodes. A vast majority of patients have improved symptoms after the procedure.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Worsening pain and swelling around the surgical wound
• Bleeding or fluid drainage from the surgical wound
• The occurrence of any symptom that causes uneasiness such as nausea, vomiting, abdominal swelling, or constipation
• Signs of an infection
• Headache, muscle aches
• Fever, feeling sick
• Dizziness
• Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Spinal Cord Stimulation surgical procedure?

At home, the following post-operative care is recommended after a Spinal Cord Stimulation procedure:

• Slowly resume regular/daily activities as early as possible
• Resume showering after surgery but keep the wound clean and dry. Avoid taking baths until the surgical wound is completely healed. Gently wash the surgical wound with mild or unscented soap
• Replace the dressings on the surgical wound after showering
• Avoid driving until permitted by physician
• Avoid lifting heavy weights, twisting, and bending too much
• Complete the course of prescribed medication under advice of the physician
• Take Antibiotic medication to help combat or prevent infection
• Avoid taking nonprescription medications, such as aspirin. However, individuals may take acetaminophen to relieve pain
• Take note of instructions given by your healthcare provider regarding making adjustments on the stimulator

How long does it normally take to fully recover, from the Procedure?

Recovery from the procedure may take a week or so.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The Spinal Cord Stimulation procedure does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Spinal Cord Stimulation surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• A hospital
• An anesthesiologist (if anesthesia was administered)
• A neurosurgeon

The patient is advised to inquire and confirm the type of billing, before the Spinal Cord Stimulation procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA