Spinal Cord Stimulation

What is permanent spinal cord stimulation?

Spinal cord stimulation is also known as neurostimulation or ESES (Epidural Spinal Electrical Stimulation). In this procedure an electrode or lead (see Figure 1) is used to apply small electric currents to certain nerve bundles in the spinal cord (number 3 in Figure 1).

The vertebral column is made up of vertebrae (see number 1 in Figure 1) in between which can be found the so-called intervertebral discs that allow the vertebrae to move against one another. At the back of the vertebra are the so-called spinous processes (number 2 in the Figure) and inside the vertebra is the vertebral canal. The vertebral canal contains the spinal cord (number 3 in the Figure) that is surrounded by cerebrospinal fluid which is turn is surrounded by a hard membrane called the dura (number 4 in the Figure). The space between this hard membrane and the bone of the vertebra is called the epidural space (number 5 in the Figure).

In spinal cord stimulation the electric currents ensure that fewer pain signals are sent to the brain via the spinal cord thereby relieving your pain. The lead is inserted into the epidural space (number 5 in Figure 1). The specific level of the spinal cord at which the lead (see Figure) is placed inside the epidural space will depend on where you feel pain. Before you are given permanent spinal cord stimulation, a test period of test stimulation is always carried out to see whether or not it reduces your pain symptoms.

 

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Figure 1. Cervical vertebra seen from above (see text). At the bottom of the image a lead can be seen inside the epidural space (5).

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Figure 2. X-ray of the vertebrae (2) taken from the front and showing the lead (1).

 

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Figure 3. X-ray of the vertebrae (2) taken from the side and showing the lead (1).

What should I be aware of before undergoing spinal cord stimulation?

Any of the following situations should be reported to your pain specialist if he proposes spinal cord stimulation:

  • If you are pregnant: since X-ray equipment is used, pregnant women may not undergo spinal cord stimulation.
  • If you are ill or have a fever on the day of treatment you cannot undergo spinal cord stimulation, in which case a new appointment will have to be made
  • If you are allergic to iodine, bandages, anaesthetics or contrast fluids, you should notify your pain specialist before the appointment for treatment is made.
  • If you are taking blood thinners, you should notify your pain specialist before the appointment for treatment is made. He will then consider whether the use of certain medications should be ceased temporarily.

How should I prepare for spinal cord stimulation?

  • No special preparations, such as an overnight bag, are necessary because the treatment is usually carried out on an outpatient basis, but we ask that you do not wear any jewellery, make-up, earrings or body piercing.
  • The treatment requires that you have an empty stomach. This means that you cannot eat or drink anything from six hours before the treatment.
  • You can take your medication in the morning.
  • This does not include blood thinners, as mentioned above.
  • You should stop taking any homeopathic medications one week before the treatment.
  • It is advisable not to smoke or drink alcohol 24 hours before and after the treatment.
  • During the treatment we ask that you do not wear make-up, nail polish, hair gel, jewellery, glasses, contact lenses or dentures.
  • You must remove any earrings, body piercing or false nails yourself.
  • Do not bring any valuables with you.
  • Make sure you have someone to take you home, since you may not drive for 24 hours.

How does spinal cord stimulation work?

  • The treatment takes place in the surgical day-care centre, where you will be asked to change into a surgical gown. This gown closes at the back.
  • A nurse will escort you to the treatment room, where there is a treatment table, an X-ray machine and television screens.
  • You will be positioned on the treatment table on your front with a cushion under your stomach.
  • Your blood pressure and the amount of oxygen in your blood will be monitored during the treatment.
  • The intervention takes several hours.
  • The X-ray machine is used to find the correct site for spinal cord stimulation.
  • This site is marked on the skin with a marker pen.
  • The area around this site is then disinfected with a cold, red liquid.
  • The pain specialist covers the area with sterile drapes in order to keep it sterile.
  • After a local anesthetic has been applied to the skin, the pain specialist will insert the lead into the correct place by means of fluoroscopy (via the television monitor).
  • Then small electrical currents are applied to the nerve bundles through the lead.
  • You will experience a tingling feeling or sensation of pressure in the area where your pain is.
  • If you notice this then you should inform the pain specialist treating you since this means that the lead is in the correct place.
  • You do not have to point to the place with your finger.
  • You are then given a sedative so that you fall asleep, following which the permanent spinal cord stimulation system is implanted.

After treatment

  • After this treatment you will be taken to a nursing ward (usually A1).
  • After you wake up your spinal cord stimulation system will be put into operation (programmed) and you will receive your first instructions about how to use the spinal cord stimulation system.
  • You must stay in bed for the first 24 hours and for the first few hours you must stay lying on your back.
  • If necessary you will be given pain medication by the nurses.
  • You will also be given antibiotics.
  • You can usually go home after 24 hours, after the doctor has seen you.

What do I need to know after I get home?

  • You must take it easy for 6 weeks.
  • No lifting or bending and no sudden movements.
  • Do not take a shower or bath for the first 2 days.
  • After this you may take a shower but not a bath until the stitches have been removed.
  • The tingling feeling can come and go depending on the position of your body.
  • The device that you have been given can be used to control the intensity of the stimulation as you so wish.
  • The stitches will be removed by your general practitioner after 10 days, unless soluble stitches have been used.
  • The operation wound will be painful for several days.
  • It feels like a bruise and heals quickly.
  • The site at which the spinal cord stimulation system is inserted can be painful for 2 to 6 weeks after the operation.

What can I use the spinal cord stimulation device for?

  • You will be given a remote control that is used to operate the spinal cord stimulation system.
  • The remote control can be used to turn the spinal cord stimulation system on and off or to adapt the intensity of the stimulation.
  • The remote control can also be used to see if the batteries are still charged and whether the spinal cord stimulation system is working properly.
  • You will be given a full instruction booklet.

What are the dangers and side effects of spinal cord stimulation?

  • There is always a risk of infection.
  • In that case you will have a headache, nausea and vomiting. Contact the hospital straight away.
  • There is a small risk of a haemorrhage around the spinal cord.
  • In that case you will have severe back pain followed by a numb and paralysing feeling in your legs.
  • Contact the hospital straight away.
  • The lead can become dislodged so that the tingling feeling is no longer in the correct place.
  • Contact the hospital straight away.

When can I expect to feel less pain after the treatment?

  • Spinal cord stimulation does not cure your pain, but it helps to make the pain more bearable.
  • You must also be aware of the fact that spinal cord stimulation may not work for you.

What is and is not permitted with spinal cord stimulation?

  • In general you can lead a normal life.
  • Always follow the instructions of your doctor.
  • Always stay under the supervision of your doctor at the outpatient department.
  • Since the stimulation can suddenly increase or become altered when driving, you may lose control of your vehicle.
  • Therefore always turn the stimulator off when driving.
  • Long car journeys should be avoided to begin with since you should not sit in the same position for a long time.
  • Take care with magnets such as those at airports.
  • For this reason you should always carry your medical ID card with you.