Spinal Cord Stimulation
Spinal cord stimulation (SCS) is a fully reversible, state-of-the-art treatment for alleviating chronic pain in the back or extremities without the use of medications or major surgery. An advanced therapy for patients who haven't responded to other treatments, SCS involves the implantation of thin flexible wires along with a small programmable stimulator device (about the size of a poker chip). This device can be programmed to deliver electrical energy in complex patterns that change the unpleasant perception of pain into a benign background tingling. Various stimulation programs can be wirelessly activated with a remote control. For example, patients who have pain when walking, but not at night can use the remote to increase stimulation while exercising and turn the device off before going to bed.
SCS is typically considered after more conservative treatments—such as injections and medications—prove ineffective. It is most often used to treat Failed Back Surgery Syndrome (also called Post Laminectomy Syndrome), which is a pain condition that can develop after spine surgery, as well as Complex Regional Pain Syndrome, which occurs when the body fails to heal properly after an injury. A growing modality, stimulation can also be applied to treating other pain syndromes including pain after chest surgery (post-thoracotomy syndrome) and headaches (occipital neuralgia).
How Spinal Cord Stimulation Works
Prior to the implant, in order to assure that the therapy is effective, trial wires are inserted in a simple office-based procedure under gentle sedation provided by one of our board-certified anesthesiologists. These wires are connected to a small external device (about the size of a cell phone) that is carefully programmed by our doctors and technicians. The patient then goes home and resumes normal activity for three – five days, in order to assess whether the therapy is helpful. If so, the leads are painlessly removed during an outpatient office visit and a stimulator implant is scheduled, within about one month.
In the stimulator implant procedure the leads and an Implantable Pulse Generator (IPG), which is a silver-dollar sized device that can be thought of as a “pacemaker” for nerves, is placed under the skin in a discreet location of the body, under comfortable sedation and local anesthesia. At Mount Sinai, this procedure is performed in an operating room, with patients typically returning home the same day.
If, for whatever reason, the spinal cord stimulator ceases to be helpful in managing pain, it can be removed in a simple procedure – a truly reversible option for pain management.
Mount Sinai's Approach to Spinal Cord Stimulation
Mount Sinai's Pain Medicine physicians have the skills and resources to perform Spinal Cord Stimulation at the highest possible level of effectiveness and efficiency. Unlike other centers that may require patients to be admitted to the hospital for the trial procedure, we have an AAAHC accredited (full anesthesia services) in-office fluoroscopy suite, which allows us to complete the trial procedure on an outpatient basis with the benefit of safe sedation.
When implanting the actual device, we are careful to invest the time and resources into achieving the best possible outcomes for each patient. While pain physicians at other centers might perform this procedure alone (most without any formal surgical training), Mount Sinai follows a different philosophy in which our pain management specialists team up with experienced surgeons to ensure perfect placement of the device and leads, and skilled, aesthetically-pleasing closure of the incision.
Mount Sinai's goal with Spinal Cord Stimulation is to carefully determine when the treatment will be most effective, and to perform the procedure and any follow-up care with the greatest skill to ensure the best possible pain relief for our patients.