What happens during the surgery?
A surgeon, anesthesiologist, or other doctor who specializes in the treatment of pain does the implanting of the spinal cord stimulator.
The complete spinal cord stimulation procedure is actually done in two stages. In the first stage, called the trial, the electrodes and wires are placed into position in the spinal canal and are left protruding through the skin. Think of this as similar to having an IV in your arm. The stimulator device can be connected to these wires and used to control the amount of spinal stimulation. The trial can last up to seven days while you test the amount of pain relief you get from using the device. If you and your doctor are pleased with the result and both of you consider the trial a success, you will be scheduled to have a second procedure where the device is implanted permanently under the skin. If you and your doctor are not pleased with the result and consider the trail a failure, the wires are removed and nothing remains inside your body. Being able to undergo a trial is one of the great benefits of spinal cord stimulation; you get to give the procedure a test drive before you commit to having the device permanently implanted.
Both the trial implantation and the permanent implantation procedures usually take place in an operating room, either in a hospital or in a day surgery facility. An operating room is a sterile environment that decreases the risk of infection. Each procedure may last up to three hours. You should be able to go home the same day.
To perform the procedure, you will be given an intravenous sedative to help you relax and a local anesthetic will be used to numb the area where the wires are inserted. A general anesthetic is not normally used, especially during the procedure for the trial implantation. You will need to be awake so that you can help guide your doctor when adjusting the device in order to provide the best pain relief.
Placement of temporary wires for the trial is a minimally invasive procedure. An epidural needle is placed through the skin and into the spinal canal near the spinal cord. This is done with the help of a special X-ray called fluoroscopy. The electrode wires are then inserted through a needle and pushed through the spinal canal until they are in the right position. The wires are then attached to the external stimulator device. Your surgeon will adjust the wires and tune the stimulator. When satisfied with the placement of the wires, a stitch to your skin is used to keep the electrode wires in place for the trial period. You are able to adjust the strength of the electrical stimulation and turn it off and on using the external device. When the stimulator is on, you should feel a tingling sensation that covers the area of your pain.
If the trial is successful, you will undergo a second procedure that involves placement of the electrode wires near the spinal cord.
The procedure for permanent placement of the spinal stimulator is very similar to the trial. The new electrodes can be placed in the same way using the needle technique, or if more precise placement is needed a small incision may be necessary over the spine. The wires are then tunneled under the skin to the area where a small incision is made to place the stimulator device under the skin. If your pain is in your legs, an incision for the device is made on your lower abdomen or upper buttock and the wires are placed in the low back.
For pain involving the arms, an incision for the device is made on the side of the chest and the wires are placed in the upper back.
A wireless controller that you should keep with you at all times controls the stimulator device. The controller allows the stimulator to be programmed to adjust the type and strength of the electric stimulation. The spinal cord stimulator is not necessarily permanent and may be removed if necessary. The battery generally lasts two to five years at which time the device must be removed surgically and the battery or the device replaced.