Spinal cord stimulation / SCS

Spinal cord stimulation is a minimally invasive procedure that is used to treat chronic pain with a so-called spinal cord stimulator system, also called neurostimulator or neuromodulator. A spinal cord stimulation system is a technical device that is implanted under the skin. It sends electric impulses to the spinal cord. This way it can help to ease or end pain that is chronic and resistant to any therapy. The electric impulses change the way of pain transmission without harming any nerve. Spinal cord stimulation is also often called a pace maker for the nervous system.

Image: spinal cord stimulation system with remote control (Photographs provided courtesy of Boston Scientific (© Boston Scientific 2010 – Do not copy or distribute) – The content of this website is under the sole responsibility of its respective authors and does not represent the opinion of BSC. Access to this site does not imply any responsibility for BSC. Please refer to BSC product DFUs for indications, contra indications, precautions and warnings.)

What is treated with spinal cord stimulation (SCS)?

The implantation of a spinal cord stimulator is useful and medically indicated in case chronic pain. At first, chronic pain is treated by drug-related pain therapy, which may not have the desired but also side effects. Aim of the spinal cord stimulation is to sustainably ease the painso that patients can return to an almost painless daily life.

Especially patients suffering from back or leg pain resistant to any therapy, or patients who have already undergone multiple spine surgery, can greatly benefit from spinal cord stimulation and enhance their quality of life significantly. This has been proven by several studies. But also patients suffering from peripheral vascular disease (PVD) or the complex regional pain syndrome (CRPS), experience a provable relief. The specialist associations do also recommend SCS in this cases.

The following medical conditions are treated with SCS and are also recognized by German insurance companies:

• chronic back pain, e.g., as a result of scarred changes after disc surgery (failed back surgery syndrome)
• complex regional pain syndrome I and II
• chronic pain resistant to any therapy in case of angina pectoris pain, e.g., after multiple treatment of coronary
• arteries by a catheter (stent placement / stenting)
• peripheral vascular disease (PDV)
• painful diabetic polyneuropathy and phantom pain

Several scientific publications have proven the positive effect on the abovementioned illnesses, but is has also been evaluated that SCS is cost-effective despite the expensive initial costs of implantation. German health insurance companies do normally cover all expenses.

Which diagnostic measures have to be carried out before the implantation of a spinal cord stimulation system (SCS)?

Before a spinal cord stimulator is implanted, we have to clarify what is causing the complaints. Due to this important factor, we will perform a thorough neurological-orthopedic examination and a comprehensive consultation. Subject to the symptoms, additional examinations like MRI or CT have to be performed in order to examine, for example, your spine in detail. Based on the results of neurological-orthopedic examination, the consultation and the imaging procedures (MRI, CT, X-raying etc.), we assess which kind of therapy is the best for you and if spinal cord stimulation is suitable to you.

All examinations can be carried out at Beta Klinik. Read more about our diagnostics.

How does the implantation of a spinal cord stimulation system (SCS) work?

SCS has 3 steps. Firstly, electrodes are implanted minimally invasively (step 1). Then SCS is tested (step 2). About a week later, the electric pulse generator is implanted during another minimally invasive surgery (step 3).

Step 1: Implantation of electrodes

Through a small surgical access at height of the middle thoracic spine, small electrodes / electronic leads are placed onto the dura, the exterior layer of the spinal cord and nerve roots. This is done percutaneously, that means through a very small tube inserted into the skin. The trial device is not implanted but remains outside the body.

Step 2: Test

The electric impulse level is easily adjustable by one hand. For 2-3 days, we test the device together with you at the ward of Beta Klinik. Then you will be discharged and test the device for 3-4 further days.
You come back to us about one week later, and we discuss the results with you. If the spinal cord stimulation has resulted into an ease of pain, or if pain has completely gone away, a permanent implantation is be possible.

Step 3: Implantation the spinal cord stimulator

During the implantation of the spinal cord stimulator, we make a small cut of about 4 cm (1.6 inches) and insert the device under the skin of the chest (occipital neuralgia) or the skin of the abdominal or gluteal area. We calibrate the device so that it works with the impulse level that has led to the greatest possible ease of pain or a painless condition. You stay at the clinic for 2-3 days after surgery. The impulse level is also individually adjustable after the operation by a small remote control.
Since the batteries of the spinal cord stimulator have a lifetime of about 8 years, the stimulator is to be changed after this period. The electrodes / electronic leads remain and are not to be changed.

What chances of success does spinal cord stimulation (SCS) entail?

If other therapy options have failed in successfuly treating your pain caused by spine or occipital neuralgia, there are good to very good chances to profit from spinal cord stimulation. However, we have to wait until the trial period is finished (see previous paragraphs) to give you a more detailed prognosis. In single cases, it is possible that the stimulator does not have the desired effects. Hence, a permanent implantation may not be useful in these cases.

The advantages of spinal cord stimulation (SCS)

• minimally invasive surgery with quick recovery
• quick relief of pain
• no side effects as known in case of drug-related pain therapy (nausea, dizziness, chronic damage of inner
• organs, obstipation, etc.)
• dynamic adjustments to the individual pain pattern are possible even after years
• patients are able to control the intensity of the spinal cord stimulation
  Disadvantages of spinal cord stimulation (SCS)
• is not effective in case of every pain type or pain location
• electrodes might shift after a rough mobilization resulting in decreased efficiency
• the spinal cord stimulator has to be changed after the discharge of batteries; rechargeable spinal cord stimulators can delay this process

Are there any risks in terms of the implantation of the spinal cord stimulation system (SCS)?

The implantation of the spinal cord stimulator and the electrodes / electronic leads is performed by experienced physicians on sterile conditions in a highly modern operating room. Due to this fact, the risks of every operation like infections, bleedings or wound healing disturbance is minimal.

How long am I unable to work after the implantation of the spinal cord stimulation system (SCS)?

You can resume work 3-4 days after surgery.

When I can I resume sports activities after the implantation of the spinal cord stimulation system (SCS)?

Normally the wound healing process lasts about 10 days, after which you can resume sports activities.

What kind of aftercare is necessary after the implantation of the spinal cord stimulation system (SCS)?

Specific aftercare is not necessary. But individually arranged consultations are useful to grant the best possible calibration of the spinal cord stimulator.