Recent advancements in technology and physiological research have helped to create neurostimulators for pain control. When these devices are used properly, they can be beneficial to the society and can provide outstanding clinical and economical benefits.

Neurostimulation is like a small TENS unit implanted on the spinal cord or peripheral nerve. It replaces pain with pleasant electrical stimulation.

Indications

• Chronic intractable pain that fails to respond to traditional oral medications, and physical treatment modalities.
• Arachnoiditis in failed back syndrome
• Complex Regional Pain Syndrome
• Peripheral neuropathy
• Phantom limb pain
• Post herpetic neuralgia

Dorsal Column Stimulator Procedure

The patient undergoes psychological screening to be qualified for the procedure and it is a two-phased procedure.

Trial of dorsal column stimulator

A temporary electrode is placed in the epidural space through a needle under fluoroscopy with a light sedation. The cables are then connected to an outside battery-powered programmer. The patient is sent home from the surgery center or physician’s office to use it for, on average, four to five days on a trial basis. I usually encourage my patients to stay active and even go to work during the trial period so that they can have a clear idea of how much this device makes them functional and productive.

The leads are taken out in the office without any significant discomfort to the patient.

Candidates for permanent placement of neurostimulator

If patient has a significant improvement during the trial period, they will qualify for the permanent implantation of neurostimulator. A patient should report at least 50% improvement in their pain levels. Other patients may be able to cut down the oral opioids and might be able to do a lot of functional activities that they could not perform before the placement of the temporary electrodes.

Placement of permanent neurostimulator

The placement of permanent stimulator is performed in the operation room under light sedation. The electrodes are placed around the epidural space through a needle and a small incision is made to implant the electrodes and the stimulator batteries under the skin. The batteries are implanted on the back of the patient below the belt-line.

The new generation rechargeable batteries can last up to seven to nine years. Placing the charger over the skin usually once a week charges the battery.

Possible complications of Dorsal Column Stimulator

Patient may develop infection after the implantation. In that case, mostly the implanted hardware (electrode and batteries) are taken out to treat the infection

The electrodes may move or dislocate in the epidural space that can result in loss of stimulation in the painful area. The patient may need a revision of the neurostimulator to reposition the electrodes. In some patients, a pad leads are implanted by a surgical incision around the spine.

Overall, it is a safe procedure in the hands of an experienced physician and needs minimum maintenance and supervision by a physician after the implantation unlike the morphine pump that requires refills in the physician’s office.