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Spinal cord stimulation (SCS) is the electrical stimulation of a precise level of the spinal cord to generate paresthesia (skin sensation) to the area(s) the patient feels pain. SCS is an accepted treatment for certain intractable pain conditions, such as:
- failed back surgery syndrome (FBBS)
- adhesive arachnoiditis
- peripheral causalgia/neuropathy
- reflex sympathetic dystrophy (RSD)
- phantom limb/stump pain
- ischemic pain of vascular origin
Successful outcomes are ensured by observing careful patient selection criteria. Patients typically do best when most of their pain involves the limbs, there is no chemical abuse, and there is minimal psychological overlay associated with their pain. Patients will be screened over a short period with a test lead to determine if proper paresthesia and pain relief are achievable.
The parameters of electrical stimulation are externally set by a programmer and are tailored to the needs of the patient.
Before any trial or permanent placement can be done, an MMPI (Minnesota Multiphasis Personality Inventory)or 500-question test must be completed first. The UCLA Comprehensive Spine Center will refer patients to a provider who can administer this test.
The initial trial involves the placement of an epidural lead into the spine for one week. A portable unit, the size of a remote control, is attached and can be placed on the patient's belt. The patient will be able to control the amount of stimulation to determine if he/she is achieving the best effects.
If the patient would like a permanent stimulator, a future surgical date will be established. The surgery does not involve an overnight stay in the hospital, and most patients are able to walk after a few hours.
The surgery involves placing the lead into the epidural space of the spine and running the lead under the skin to the site of the stimulator unit. The unit is the size of a pager and is placed under the skin.
If the unit does not feel right or does not give proper pain control, it is easily removed.