Spinal Cord Pacemaker

Spinal Cord Pacemaker

A spinal (pain) pacemaker is a device that sends a low-level electrical current to the spinal cord to relieve pain. The current blocks pain signals from reaching your brain.

What is a spinal cord pacemaker and how does it work?

The first spinal cord pacemaker use dates back to 1968. In 1981, the first fully implantable system was introduced. Since then, spinal cord pacemaker technology has become more effective.

A spinal pacemaker consists of thin cables (electrodes) and a generator (neurostimulator). The electrodes are placed between the spinal cord and the vertebrae (epidural space), and the generator is placed under the skin in a special location in the painful area.

Spinal pacemakers allow patients to relieve their pain by sending electrical impulses via remote control when they feel pain. The remote control can turn the pacemaker on/off and increase/decrease the stimulation level. It can also activate a special program for the patient to cope with pain.

How many types of spinal cord pacemakers are there?

Which spinal cord pacemaker you will use; is determined by your doctor according to the intensity, area of ​​your pain, your health condition and your expectations.

  • Traditional spinal cord pacemakers (IPG) replace the feeling of pain with a slight tingling sensation called paresthesia. These batteries are placed in the spine with an operation. When the battery runs out, a new operation is required for replacement. The lifespan of these batteries is generally 2 to 5 years. Since they have a lower electrical output, they can be a good choice for people who only have pain in one body part. Some patients prefer newer generation batteries that reduce the tingling sensation caused by the battery.
  • Rechargeable IPG works similarly to traditional devices, with the difference that the battery can be recharged without any further surgery. Since the energy source is rechargeable, these batteries can deliver more electricity. They may be a good choice for people with pain in the lower back or one or both legs, because the electrical signal can reach farther. Rechargeable battery systems can last 8 to 10 years or longer.
  • Radio frequency systemsuse an external power source for those who need high-frequency stimulation. They have rechargeable batteries and may be more suitable for people with lower back and leg pain because of their power.

Some devices can detect changes in body position (sitting or lying down) and adjust the stimulation level according to your activity. Other advanced systems also have cables that can be independently programmed to cover multiple pain areas.

Some newer devices have the advantage of being able to use a variety of waveforms for electrical delivery, including high-frequency and high-intensity stimulation.

Your surgeon will explain how to operate the device and how to adjust the intensity of the electrical signal that all three types of stimulators support.

What disorders are spinal cord pacemakers used for?

Spinal pacemakers are generally preferred when nonsurgical pain management options do not provide adequate relief.

Painkillers can be used to manage different types of chronic pain, including:

  • Back pain, especially after surgery (also known as failed back surgery syndrome and persistent spinal pain syndrome)
  • Post-operative pain
  • Arachnoiditis (painful inflammation of the arachnoid, a thin membrane covering the brain and spinal cord)
  • Heart pain that cannot be treated by other means (angina)
  • Spinal cord injuries
  • Nerve-related pain (severe diabetic and cancer-related neuropathy from radiation, surgery, or chemotherapy)
  • Peripheral vascular disease
  • Complex regional pain syndrome
  • Pain after amputation
  • Visceral abdominal pain and perineal pain

Spinal pacemakers can improve overall quality of life and sleep can improve pain and reduce the need for pain medications. Painkillers are often used in conjunction with other pain management treatments, such as medications, exercise, physical therapy and relaxation methods.

Who is a suitable candidate for a spinal cord pacemaker?

As with all treatments, your doctor will want to make sure that a spinal stimulator is a beneficial choice for you and is likely to provide significant relief from your chronic pain.

Every patient is different, but in general, those who benefit most from a spinal stimulator are those who have not had adequate relief from their pain with medications, less invasive treatments, or previous surgeries.

Who cannot have a spinal cord pacemaker?

Here are some people who may not be candidates for a spinal cord pacemaker:

Pregnant Women: If you are pregnant or planning to become pregnant, a spinal cord pacemaker may not be recommended due to the potential risks to both the mother and the developing fetus.

Those with Active Infections or Bleeding Disorders: They may not be suitable candidates for a spinal cord pacemaker because of the additional health risks it poses during the implantation process.

Those with Unrealistic Expectations: People who have unrealistic expectations about the results of a spinal cord pacemaker may not receive the full benefit of the pacemaker. It is important to have a realistic understanding of the possible outcomes and limitations of treatment.

Those with Untreated Psychiatric Conditions: If untreated psychiatric conditions, such as severe depression or psychosis, are present, these issues may need to be addressed before considering a spinal cord pacemaker to ensure the safety and success of treatment.

Those Who Do Not Benefit From a Trial: If the pain does not significantly decrease during a trial of a spinal cord pacemaker, it may be considered unlikely that the device will be useful.

What is the spinal cord pacemaker trial process?

There are two stages to the spinal cord pacemaker trial procedure. The first is the trial, and the second is the surgical placement of the pacemaker.

During the trial phase, your surgeon will place a temporary device in your body for you to test. If you are taking blood thinners, you will need to stop taking them 3 to 7 days before the trial.

A local anesthetic is given to numb the area before the operation. Guided by an X-ray device called fluoroscopy, the surgeon places electrodes in the epidural space of the spine. The location of your pain will affect where these electrodes are placed along your spine. Your surgeon may ask for your feedback during the procedure to best position the electrodes. This trial procedure usually involves an incision in your lower back to place the electrodes. Over the course of about a week, you will evaluate how well the device is reducing your pain. If you experience a 50% or greater reduction in your pain level, the trial is considered adequate. In this case, surgery is scheduled to permanently place the device. If the trial is unsuccessful, the device is removed. During the trial, you will need to avoid activities that will get your device wet, such as showering or swimming.

How to prepare for spinal cord pacemaker surgery?

If the Stimulator trial is successful and you feel more than 50% improvement in your pain, you will be scheduled for surgery to permanently implant your device in your body.

You will be asked to stop taking all nonsteroidal anti-inflammatory drugs (ibuprofen, naproxen, etc.) and blood thinners 7 days before surgery. Nicotine and alcohol should be stopped 1 week before and 2 weeks after surgery to prevent bleeding and healing problems.

How is spinal cord pacemaker surgery performed?

The spinal cord stimulator operation usually takes 1 to 2 hours and is performed under general anesthesia. The electrodes are placed in the epidural space of the spine through a small incision with the help of fluoroscopy and secured with stitches. The electrodes do not directly contact your spinal cord.

If necessary, a test stimulation is performed to make sure the electrodes are effectively covering the pain areas. In new generation devices, the electrodes can be positioned according to the anatomy or electrical tracing of the nerves to provide feedback without you having to be woken up.

In some cases, if the electrodes placed during the trial are perfectly positioned, there is no need for repositioning or new electrode placement.

Once the electrodes are positioned, a small incision is made below the waistline to create an area under the skin to place the generator. The electrodes are connected to the generator with a cable. The generator is then placed in the designated area.

Where the generator is placed depends on several factors. Your surgeon will usually place the generator just above or below the level of your belt on the side that is most accessible to you. They may also choose to place it on the opposite side of your body from where you prefer to sleep. The incisions are then stitched shut and the surgery is completed.

The generator programming process can take place in the operating room, in the hospital room after surgery, or both.

Most patients are discharged the same day or the next morning. Written instructions for when you go home will be given to you when you leave the hospital. It is important to follow your surgeon’s home care instructions for the first 2 weeks after surgery or until your follow-up appointment.

What is the process after the spinal cord pacemaker operation?

Every patient is different. However, in general, you will be asked to follow the following restrictions during the post-operative period:

  • You should take painkillers as recommended by your surgeon.
  • It will be beneficial to apply ice to your incision for 15-20 minutes 3-4 times a day to reduce pain and swelling.
  • Do not sit or lie in the same position for more than an hour unless you are sleeping. Stiffness causes more pain.
  • Get up and walk for 5-10 minutes every 3-4 hours. Gradually increase your walking as much as you can.
  • You should not bend, lift, bend your back, or reach overhead for the next 6 weeks. These precautions are to prevent the wires from becoming dislodged while they heal.
  • You should not do any strenuous activities, including gardening, housework, or sex.
  • You should not drive until your follow-up appointment.
  • You should not drink alcohol, as it thins the blood and increases the risk of bleeding.
  • You should wash your hands thoroughly before and after cleaning the incision to prevent infection.
  • Clear, pinkish discharge from the incision is normal. However, you should pay attention to the consistency of the discharge and any redness, and consult your doctor if necessary.

FAQ ABOUT SPINAL CORD PACEMAKERS

1- Can a spinal cord pacemaker be placed in patients of all ages?

A spinal cord pacemaker is usually used for adult patients, especially those with chronic pain that has not responded to other treatments. Although there is no specific upper age limit for the procedure, the procedure is more commonly recommended for adults because of the complexity of pain management and the need for careful patient selection.

Spinal cord pacemakers are rarely used in children or adolescents, and the decision is made on a case-by-case basis. In this group, doctors evaluate factors such as the severity of the condition, alternative treatments, and the child’s general health.

2- Is a spinal cord pacemaker procedure painful?

Since a spinal cord pacemaker procedure is usually performed under general anesthesia, patients do not feel pain during the surgery. However, it is common to feel some discomfort or pain at the incisions where the electrodes and generator are placed after the surgery.

Postoperative pain is usually mild to moderate and can be managed with painkillers. Most patients recover within a few weeks. However, it is important to follow your doctor’s instructions regarding wound care and activity restrictions to avoid complications.

3- When is a spinal cord pacemaker replaced?

A spinal cord pacemaker is usually replaced in the following cases:

Battery Depletion: Over time, the generator battery may run out, especially in non-rechargeable models. When the battery is depleted, the device must be replaced with a minor surgical procedure.

Device Failure or Damage: Replacement may be required if the battery components fail, become damaged, or shift from their original position.

New Technology: As technology advances, patients may choose to replace their devices with devices that offer better pain relief, programming options, or rechargeable battery systems.

4- Are there any side effects of a spinal pacemaker?

Complications of a spinal cord pacemaker procedure are rare. However, no procedure is without risk. A small percentage of patients may experience:

  • Infection, which may occur in the first 2-8 weeks
  • Bleeding
  • Displacement of the device (in this case, a second operation is usually performed to put the electrodes back in the correct place.)
  • Device damage
  • Severe headaches due to leakage of cerebrospinal fluid
  • Nerve damage and paralysis, although extremely rare

5- Will my pain go away completely with a spinal cord pacemaker?

The success rate of a spinal cord pacemaker depends on careful patient selection, successful trial stimulation, proper surgical technique, and patient education. A spinal pacemaker does not cure the condition that is causing the pain; it helps patients manage the pain. If the pain is reduced by at least half, the operation is considered successful.

Published studies on spinal cord stimulation show long-term relief in 50% to 80% of patients with chronic pain. One study reported that 24% of patients improved enough to return to work with stimulation alone or occasional oral pain medication.

6- Can I have X-rays, CT scans, and MRIs with a spinal cord stimulator?

X-rays and CT scans are generally safe as long as your spinal cord stimulator is off. You should inform your healthcare provider that you have a spinal cord stimulator before any scan.

MRIs are not always safe for those with a spinal cord stimulator. Some newer batteries are compatible with certain MRI machines. However, the doctor must first evaluate the characteristics of your stimulator. If your device is not compatible, MRIs can cause serious injury.

7- Will my spinal cord stimulator cause problems at airport checkpoints?

Yes, airport security gates will detect the battery. However, your doctor may give you a document/card that will help you go through this safety procedure.

8- Can I drive with a spinal cord pacemaker on?

No, you should turn off your pacemaker while driving or using heavy machinery because sudden changes in stimulation levels can cause distraction.

9- Can I swim with a spinal cord pacemaker?

Swimming with a permanent generator is fine. However, you should not get the pacemaker wet. You will also need to avoid bathing and showering during this short trial period.

10- How much does a spinal cord pacemaker improve my quality of life?

The effects of chronic pain extend beyond the physical realm, often affecting our emotional state and limiting our participation in basic activities. Patients with a spinal cord pacemaker experience increased enjoyment of life.

* You can find more detailed information about spinal cord stimulation on our epidural stimulation page.

* The content on our website is for informational purposes only. Please consult your doctor for medical treatment. Our content does not include information about therapeutic health services in our hospital.

Sources:
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  • https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/treating-pain- with-spinal-cord-stimulators
  • Nguyen B, Thottakara J, Bell KR. Patient Management for Traumatic Brain Injury. In: Mitra R. ed. Principles of Rehabilitation Medicine. McGraw-Hill; 2019.
  • Petersen EA, Schatman ME, Sayed D, et al. Persistent Spinal Pain Syndrome: New Terminology for a New Era (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8197591/). J Pain Res. 2021;14:1627-1630. Accessed 10/3/2022.
  • Sundaraj SR, et al: Spinal cord stimulation: A seven-year audit. J Clin Neurosci 12:264-270, 2005
  • Vakkala M, Järvimäki V, Kautiainen H, et al. Incidence and predictive factors of spinal cord stimulation treatment after lumbar spine surgery (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5634380/). J Pain Res. 2017;10:2405-2411. Accessed 10/3/2022.
  • Verrills P, Sinclair C, Barnard A. A review of spinal cord stimulation systems for chronic pain. J Pain Res 9:481-92, 2016

* The information on our website has been prepared for informational purposes only.

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