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Spinal Cord Stimulator Placement Procedures

Spinal cord stimulation is a technique used to address chronic back pain when more conservative treatment methods have failed. It involves surgical implantation of an electrical device near the spinal cord that replaces pain messages from the brain with a more tolerable tingling sensation. The procedures for placement of a stimulating device vary according to several factors.

  1. Use of a Trial Device

    • According to the American Association of Neurological Surgeons, the first step in stimulator placement is temporary use of a trial device to determine whether a permanent device will be effective. If you are a candidate for permanent implantation, your surgeon will use an external stimulator that closely approximates the pain relief mechanisms used in long-term placement. Typically, this stimulator will be programmed with a number of different pain-relieving settings, which will be tested to determine if spinal cord stimulation will work for you. If you benefit from the treatment, your surgeon will then determine which particular device settings prove most effective. This trial period may last from one day to several weeks.

    Types of Stimulators

    • If the trial results are positive, you will be scheduled for permanent implantation. All spinal cord stimulators consist of two main parts: a pulse generator that creates an electrical signal, and a lead wire that carries the signal to the area designated for treatment. Within this overall design, two different types of stimulators are commonly used. Fully implanted units are placed entirely inside your body, and require use of a non-rechargeable battery that must be periodically removed and replaced. Radio frequency devices use an external transmitter and antenna that control a receiver implanted in your body. In consultation with your doctor, you will determine which type is most effective for your circumstances.

    Lead Wire Placement

    • Another consideration is the location of the lead wire. In some cases, the wire is placed under the skin through a small incision near the spinal cord. If you undergo this form of implantation, the procedure will be performed under local anesthetic. Your surgeon may instead place the lead wire in close proximity to the spinal cord. This procedure, which requires general anesthesia, begins with the removal of a small part of one of your vertebrae to allow access to the spinal cord. Once this is done, the stimulator's lead wire is placed in the space between your spinal cord and vertebra.

    Assessing Placement

    • After your lead wire is placed, your surgeon will turn it on to make sure it is working properly. If you are under general anesthesia, you will be awakened for this assessment. In addition to judging the effectiveness of pain relief, you will be asked to assess the comfort of the wire's placement. If needed, your surgeon may adjust the wire's location, or place additional wires to widen the area of pain relief. Once lead wire placement is completed, your generator will be implanted. If necessary, you will be given additional anesthesia before this phase begins. After your procedure, you will be given instructions on surgical recovery and long-term care of your implanted stimulator.

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