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Spinal Cord Stimulator in San Francisco

Spinal cord stimulator belongs to neuromodulation, an evolving field in cranial and spinal surgery. It is a tool that is used for control of chronic pain and unpleasant sensation in both upper and lower extremities.

Occasionally it is a tool that is used for pain control after prior spinal operations have failed (so-called failed back syndrome). Sometimes it is used for intractable neuropathy, such as diabetic neuropathy or post-radiation or post-chemotherapy neuropathy. It is also used for damaged nerves and a condition called RSD (reflex sympathetic dystrophy), also known as CRPS (complex regional pain syndrome).

Thoracic spinal cord stimulator procedure can be done on an outpatient basis and involves performing laminectomy in the thoracic spine (unroofing of the spinal canal) usually done in the lower part of the thoracic spine anywhere from T8 down to T12. Then, electrodes are placed within the spinal canal, outside the spinal cord.

A separate battery, similar to that used for pacemakers, is implanted, usually in the buttock subcutaneous, meaning under the skin, or around the flank. At the completion of the procedure, the paddle with the actual electrodes in the thoracic canal is connected to the battery in the buttock via tunneling. Postoperatively, the patient uses a remote control to control the specific programs that dictate the frequency of electrical discharges, amplitude, and so forth.

Spinal cord stimulators operate based on what is called gate theory; however, the exact mechanism of action is not known. The majority of spinal cord stimulators create so-called paresthesias or sensations of pins and needles, which overwhelms the sensation of pain. Prior to the placement of the spinal cord stimulator, patients go through what is called a trial procedure, which involves a pain management physician placing little wires (percutaneous leads) through a large needle into the spinal canal.

The procedure is quite similar to an epidural injection; however, instead of injecting steroid into the spinal canal, an electrode is being placed. The externalized part of the electrode is connected to a battery, and the trial usually takes place over the course of two to five days, when the patient gets to “test drive” the stimulation and see if that is something that benefits his or her pain.

If the patient finds that the pain is significantly decreased, the sensation of pins and needles was not unpleasant, and function overall has improved, as well as the intake of pain medications decreased, then the trial is deemed to be successful. After this, the patient is referred to a spine surgeon for the placement of a permanent system. Spinal cord stimulation can be done in the thoracic spine and the cervical spine, depending on the patient’s needs.

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