Spinal Cord Stimulation

A spinal cord stimulator trial (SCS trial) is a procedure used to evaluate whether a spinal cord stimulator (SCS) could be an effective treatment option for your chronic pain. The goal of the trial is to determine whether a permanent spinal cord stimulator can provide significant pain relief and improve your quality of life. The procedure is performed under fluoroscopic guidance, which involves using real-time X-ray imaging to ensure precise placement of the leads (thin wires) in the spinal area. Here’s a detailed explanation of the trial process, its purpose, benefits, and other important aspects of the procedure.

What is a Spinal Cord Stimulator?

A spinal cord stimulator is a device that delivers low-voltage electrical pulses to the spinal cord to mask or reduce pain. It is typically used for patients with chronic pain, especially those who have not responded well to other treatments like medications, physical therapy, or surgery. The stimulator works by interfering with pain signals traveling to the brain, effectively “distracting” the brain from the pain signals.

Why is a Spinal Cord Stimulator Trial Done?

The spinal cord stimulator trial is a critical step before deciding to proceed with permanent implantation. Not every patient will respond well to spinal cord stimulation, so the trial allows your doctor to assess whether the treatment will be effective in managing your pain. A trial helps both you and your doctor make an informed decision about whether a permanent spinal cord stimulator would be beneficial for long-term pain relief.

The trial is generally considered for patients who have:

Chronic pain that hasn’t been sufficiently relieved by other treatments, including medications, physical therapy, and other surgical interventions.
Pain conditions such as diabetic neuropathy, failed back surgery syndrome, complex regional pain syndrome (CRPS), neuropathic pain, or other types of severe, chronic pain.
Unsuccessful outcomes from traditional pain management strategies.
A desire to avoid or delay more invasive procedures, such as major spinal surgeries, or when surgery isn’t a viable option.

Procedure Overview

The spinal cord stimulator trial is performed in a sterile setting, typically an outpatient surgical center or hospital. The procedure itself usually takes between 45-60 minutes, and while the trial is minimally invasive, it’s performed under local anesthesia with fluoroscopic guidance. Let’s break down the steps involved:

1. Pre-Procedure Preparation

Assessment: Prior to the procedure, your doctor will review your medical history and any imaging studies (like MRI or CT scans) to ensure you’re a good candidate for spinal cord stimulation. You’ll also undergo a physical examination to evaluate your pain symptoms and determine the most appropriate location for lead placement.
Anesthesia: The trial is performed under local anesthesia. You’ll be awake during the procedure, but the area where the leads are to be inserted will be numbed. In some cases, light sedation may be offered to help you relax.
Positioning: You’ll be positioned on the procedure table, typically lying on your stomach. Your back will be cleaned and sterilized to minimize the risk of infection.

2. Lead Placement with Fluoroscopic Guidance

Fluoroscopy: Fluoroscopy is a type of real-time X-ray used to guide the physician as they place the leads. It allows them to visualize the precise location of the lead placement in the spinal cord area.
Needle Insertion: A needle or needle-like device is used to access the epidural space (just outside the spinal cord). The doctor will use fluoroscopy to direct the needle to the correct location.
Lead Placement: Through the needle, small, flexible wire-like leads are inserted. These leads contain electrodes that will emit electrical pulses to modulate the pain signals in your spinal cord. The leads are typically placed in the epidural space in the lower back (lumbar region) or upper back (thoracic region), depending on where the pain is originating.
Testing the Leads: Once the leads are in place, the physician will test the system by sending electrical pulses through the leads to see if it produces a tingling sensation (called “paresthesia”) in the area where you feel pain. The goal is to position the leads in such a way that you feel this tingling sensation in the same area where your pain is located. This helps confirm that the stimulator is correctly placed.

3. External Stimulator Connection

The leads are temporarily connected to an external spinal cord stimulator device. The stimulator is typically worn on a belt around your waist, and it is controlled by a small handheld programmer that adjusts the intensity of the stimulation.
The external stimulator delivers electrical impulses to the leads, providing pain relief while allowing you to assess how well the system works. You will be asked to move around, sit, stand, or walk to see how the stimulation impacts your pain in different positions and activities.

4. Post-Procedure Care

After the leads are placed, you will be monitored for a short period to ensure that the procedure was successful and that you’re not experiencing any immediate complications.
You may feel some discomfort or soreness at the site where the leads were inserted, but this should be temporary.
Your doctor will give you specific instructions for follow-up care and how to manage the external stimulator device.

Trial Period

The trial typically lasts between 5 to 7 days. During this period, you will have the opportunity to evaluate how well the spinal cord stimulator reduces your pain. You’ll be asked to keep track of your pain levels and how the stimulation impacts your daily activities. The external stimulator will be adjusted periodically by your doctor or pain management team to find the optimal settings.

Benefits of a Spinal Cord Stimulator Trial

Pain Relief: Many patients experience a reduction in pain during the trial. While not everyone will respond positively, those who do can achieve significant relief, often in the range of 50% to 70%.
Minimally Invasive: The trial is a relatively low-risk, minimally invasive procedure that allows for an assessment of spinal cord stimulation without committing to permanent implantation.
Improved Quality of Life: Successful trials can result in improved mobility, sleep, and overall quality of life, as patients experience a reduction in pain and discomfort.
Non-Surgical Option: For those with chronic pain, spinal cord stimulation offers an alternative to more invasive procedures, like spinal fusion or other major surgeries.

Considerations and Risks

While spinal cord stimulation can be highly effective for some, it’s not without risks or considerations:

Infection: There is a small risk of infection at the site where the leads are inserted.
Lead Migration: The leads can shift position during the trial, which may reduce effectiveness or require repositioning.
Device Malfunction: The external stimulator can malfunction or fail to deliver the appropriate level of stimulation.
Non-Response: Some patients may not experience significant pain relief during the trial, which may indicate that spinal cord stimulation is not the right treatment for them.

After the Trial

At the end of the trial period, you and your doctor will assess whether spinal cord stimulation has provided sufficient pain relief. If it has, you will be scheduled for a permanent implantation of the spinal cord stimulator. If the trial doesn’t result in significant pain relief, you may explore other treatment options.

Conclusion

The spinal cord stimulator trial is a valuable step in determining whether this technology can help manage chronic pain. By offering a temporary, non-invasive way to assess the potential benefits of a permanent stimulator, the trial allows you to make an informed decision about whether this treatment will improve your quality of life. The procedure is performed under fluoroscopic guidance to ensure precise lead placement, and it offers many patients significant pain relief with minimal risks. However, not all patients respond to spinal cord stimulation, so it is essential to work closely with your pain management team throughout the trial process to determine the best approach for your individual needs.