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Spinal cord stimulation

Spinal Cord Stimulation (SCS) or neuromodulation may offer hope for people world wide who suffer from chronic pain from failed back surgery. The incidence of lumbar spine surgery in the UK is 5 in every 10,000 people with failure rates of spinal surgery quoted in the literature as ranging between 10% and 40%.

 

The technology

Spinal Cord Stimulation (SCS) or neuromodulation sends electrical impulses that trigger nerve fibres along the spinal cord, masking the pain message traveling to the brain. When this happens, the painful sensation is replaced with a soothing, tingling sensation. The sensation itself is pleasant and in most cases the patients can’t “feel” it. Spinal Cord Stimulation (SCS) or neuromodulation may also be prescribed for chronic intractable pain of the trunk and/or limbs, including unilateral or bilateral pain associated intractable low back pain and leg pain. Many people with failed back surgeries have had success with the Spinal Cord Stimulation (SCS) or neuromodulation 


The system

A typical Spinal Cord Stimulation (SCS) or neuromodulation system has four components:

  • A neurostimulator or a “battery” that generates an electrical pulse (or receives radio frequency pulses) – this is surgically implanted under the skin in the abdomen or in the buttock area. 
  • An electrode(s) implanted near the spinal cord percutaneously (through a needle, rather than through an open surgical incision, of the skin).
  • A lead that connects the electrode(s) to the neurostimulator.
  • A remote controller that is used to turn the neurostimulator on or off and to adjust the level of stimulation.


The Procedure

Spinal Cord Stimulation (SCS) or neuromodulation is minimally invasive and reversible. This is done as a day case procedure and the patients are able to go home the same day in most of the circumstances. This is done two stages allowing the patient to have experience with the temporary system, before undergoing the “battery” insertion. This allows the advantage (as opposed to surgery) that patients are able to assess if  this therapy would help them or not. 


The Evidence

The procedure is recommended by NICE guidance for intractable neuropathic (nerve related) pain Guidance 159 and is part of standard of care of pain management in these patients who have undergone failed back surgery or pain unresponsive to medications. It is usually considered after standard treatments (such as injections/ epidurals/ pain killers) have failed. 

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