Spinal cord stimulation for peripheral arterial disease is a therapy that uses electrical impulses to decrease pain from being perceived in the brain. Instead of pain, the patient feels a more pleasant tingling sensation. Most patients report a 50%- 70% decrease in pain. The goal is to lower the level of pain and make it more manageable.
Am I a Candidate?
After you and your physician determine that you are a candidate to try spinal cord stimulation, a trial will be arranged to learn if it will be effective in treating your pain. The trial involves a procedure to place a temporary stimulator to determine if the area of your pain will be covered by stimulation, and if the stimulation actually reduces your pain. The trial typically lasts 7-10 days. You will want to be certain that you have satisfactory pain control and that you are comfortable with the sensations of stimulation. If the trial is successful, the permanent stimulator implantation will be scheduled.
How does Spinal Cord Stimulation Work?
Spinal cord stimulation will take place in an outpatient in an operating room. You will be given a local anesthetic and sedation but at some point in the procedure you will be awake with minimal discomfort in order to give feedback to the physician regarding effective stimulation. The stimulator lead is inserted within the epidural space using a special needle through the skin for a trial procedure, or through an incision for long term placement. Once the lead is in place, your physician will activate the system. You will help the physician determine how well the stimulation pattern covers your pain pattern.
If this is a trial procedure, the needle(s) are removed and the stimulator lead(s) anchored to the skin and then covered with a bandage. The lead(s) are then temporarily connected to an external battery pack. For long term implantation, The needles are removed and then placed subcutaneously under the skin to a internal battery pack (generator). The generator is place through another incision typically just above the waistline on either side of the spine.
Risks of Surgery
Any time surgery is performed there are possible complications. For spinal procedures, these rare risks include:
- Infection
- Bleeding
- Headache
- Paralysis, loss of bladder/bowel function
- Allergic reaction
- Pneumothroax
- Spinal fluid leakage
After the stimulator trial procedure, there is usually little discomfort other than that caused by the dressing and tape. You must keep the bandaged area dry and therefore must sponge bathe until the lead is removed at your follow-up visit in 7-10 days.
Post-Surgery
With the implantation/long term placement spinal cord stimulation procedure, you will have some discomfort at the incision sites, and there will be some swelling which usually lasts for several days. There will be some discomfort over the area where the generator is implanted. This is normal. Immediately following implantation, you should avoid extreme lifting, bending, stretching and twisting for the first 6-8 weeks. Light exercise, such as walking is important to build strength and to help relieve pain. Leads can remain permanently in place. However, if you engage in extreme bending, stretching, twisting, or strenuous activity such as jumping exercises and diving, etc., the leads may move or become damaged and require surgical repositioning or removal. This can occur especially within the first 8 weeks after implantation.
Things to Keep in Mind
Do not drive a motor vehicle or heavy equipment while using the stimulator. You may use it if you are a passenger. The stimulator will set off metal detectors (such as at airports). You will want to be sure you have your SCS identification card in order to pass through. Department store theft detectors may cause an increase or decrease in stimulation as you pass through. This is temporary and will not harm you or the stimulator however, you may wish to turn the stimulator off before passing through. Anything with magnets can affect your stimulator in addition to theft detectors and metal detectors, be mindful of large stereo speakers with magnets, high voltage power lines, electric arc welding equipment, electric sub-stations and power generators. Magnets can turn an internally powered generator on or off.
You will want to AVOID MRIs (unless specifically told otherwise) as they can damage the stimulator and/or cause injury. Normal household equipment will not harm or interfere with the stimulator. This includes cellular or portable phones, microwaves, computers, TVs, appliances, electric blankets and heating pads. The stimulator control magnet may cause damage to certain items or erase information on items with magnetic strips (bank or credit cards), magnetic media (video cassette tapes, computer diskettes, cassette tapes), and home electronic items (computer, VCR, television, camera). The magnet will stop watches and clocks, so you will want to store the magnet at least two inches away. Life of batteries depends upon stimulation settings and usage. External batteries last anywhere from several hours to several days.
When the battery of an implanted pulse generator is depleted, you may need surgery to replace the generator. Report to your doctor’s nurse changes in stimulation patterns, increase in pain, or unexplained increased / decreased stimulation.