Spinal cord stimulation

What it treats, and what the evaluation decides

Spinal cord stimulation is for long-lasting pain, usually nerve-related, that hasn’t responded to other treatment. Common examples are back and leg pain that persists after spine surgery and painful diabetic neuropathy.

The evaluation answers three questions: what is most likely causing your pain, whether simpler options are still worth trying, and whether a stimulator trial makes sense for you. A stimulator changes how pain signals reach the brain. It doesn’t repair the underlying problem.

Who may be considered, and what can rule it out

Medicare describes spinal cord stimulation as a late, if not a last, resort for chronic intractable pain. Its conditions give a good picture of who is considered:

• Medicines, surgery, or physical or psychological therapies have been tried without satisfactory results, or aren’t suitable for you
• A careful physical and psychological evaluation before implantation (Medicare requires both; ask whether your plan does)
• A temporary trial that shows pain relief before any permanent implant

MRI: it isn’t safe to have an MRI with most stimulators. Tell your physician if you’re likely to need MRI scans, and always tell imaging staff you have one. Your physician also checks for anything that would make the procedure unsafe for you.

Alternatives to discuss

Depending on the cause, your physician may also discuss other care we offer, such as physical therapy, medicine changes, epidural injections or nerve blocks, radiofrequency ablation for joint-related pain, peripheral nerve stimulation for pain in one area, or a spine surgery opinion when a structural problem may be fixable.

What to bring to your evaluation

• Reports of recent MRI, CT or X-rays, and the images if you have them
• Operative notes from any spine surgery
• A list of treatments you’ve tried, roughly when, and how much they helped
• Your medicine list, including blood thinners
• Insurance card, and a claim number for a car accident or work injury

What happens, step by step

1. EvaluationHistory, exam and imaging review, and the screening your insurer requires.
2. TrialThin leads are placed in the epidural space and connected to a small generator you wear outside the body. It’s usually an outpatient procedure, and the trial often lasts a few weeks. You use it during normal daily life and keep track of your pain and activity.
3. DecisionA trial is usually counted as successful when it reduces your pain by at least half. If it doesn’t help enough, you don’t have to get the permanent implant.
4. Permanent implantIf the trial helped, the leads and a small battery are implanted a few weeks later. The battery usually sits near the top of the buttock. The system is tested and programmed before you leave.
5. Follow-upA wound check around two weeks later, then programming visits to adjust stimulation.

Preparation and practical limits

• During the trial, keep the leads and the outside generator dry.
• After the permanent implant, avoid bending, stretching, exercise and heavy lifting for the period your surgeon gives you. It often takes four to six weeks to get used to the leads.
• Turn the stimulator off before driving or using machinery or power tools.
• Ask before your procedure how to handle blood thinners. Don’t stop one without the prescribing doctor’s advice.
• Plan for a ride home after the trial and the implant.

Risks, and why results vary

The most common problems are leads moving out of place, breaking or not working correctly; infection; and unwanted tingling or numbness. The generator can also fail or malfunction. Spinal cord injury is rare. Pain relief can also fade over time.

Results vary with the cause of the pain, how long it has been present and how well the stimulation covers the painful area, which is why the trial comes first.

If the trial or the stimulator doesn’t help enough

If the trial doesn’t help enough, no permanent device is placed, and your physician goes back over the other options with you. If a permanent stimulator stops helping, talk with your physician about the options. Not enough relief is the most common reason stimulators are removed, which is a separate procedure.

Cost and coverage

When it’s medically necessary, this procedure is usually billed to health insurance, Michigan auto no-fault or workers’ comp, and most plans need prior authorization. Insurers often have their own requirements before approving an implant. Our team checks your benefits and the authorization before anything is scheduled and tells you about any cost you’re likely to owe. The surgery center or hospital may bill separately from the physician; ask us which charges to expect. See who usually pays · Ask us to check your coverage

Related reading

• Peripheral nerve stimulation
• Neuromodulation
• Peripheral neuropathy

Where to get care at Specialty Medical Center

Evaluations are with our interventional pain physicians in Dearborn and Sterling Heights. Part of Neuromodulation.

Eduardo José Otero Loperena, MDInterventional pain medicineMohamed Osman, MDPain managementAaron Greenberg, DOPhysical medicine and rehabilitation

Who performs procedures, and where:

• Dr. Eduardo José Otero: Universal Care Surgery Center
• Dr. Mohamed Osman and Dr. Aaron Greenberg: Universal Care Surgery Center and Advanced Surgery Center
• Dr. Roy Torcuator: Advanced Surgery Center and Garden City Hospital

Office injections are done in our offices. Your physician confirms who performs your procedure, and where, at your consultation.

Sources

• Medicare National Coverage Determination 160.7, Electrical Nerve Stimulators
• Cleveland Clinic: Spinal cord stimulator (SCS)
• Johns Hopkins Medicine: Spinal cord stimulator removal, Q&A with a neurosurgeon

This page gives general information. Your physician will explain whether a treatment fits you, its risks and the alternatives.