FAQs patients

It is important that you be able to lie face down on an operating table for an hour or two during the first part of the procedure. Although some patients say they find this difficult, in practice, with the anaesthetist providing a level of relaxation and with plenty of local anaesthetic, few people find this a major problem. It will be possible to move around and wriggle a little during the operation and if at any time you find the procedure extremely painful, it can be stopped in a matter of minutes. It is important that all narcotic drugs be stopped before the operation and this may require a week or more in hospital. During the trial stimulation, relatively little will be provided in the way of painkillers, to enable us to determine whether or not the stimulation is useful in the relief of your pain. Over all, the surgery involved is relatively minor and in no way comparable to major spinal surgery such as is involved with disc removal. Most patients are able to leave hospital after 1-3 days, and, if implantation has proceeded, more than 80% of patients have satisfactory pain relief after three months and after two years, about half the patients still express great satisfaction with the system. Technical problems, such as movement of the electrode, breakage of the wire or other failure of the system, may require further minor operations but it is usually the case that the system can be made to function satisfactorily once again.

Spinal cord stimulation may be appropriate for you if you meet the criteria listed below.

Medical, physical and psychological factors are all important and all potential patients undergo assessment by a pain doctor and a psychologist. The criteria below list reasons why spinal cord stimulation may not be appropriate for you. All patients who go forward for stimulation attend either a technology day or a two week preimplant programme, for education about spinal cord stimulation and physical and psychological health strategies. 

• What are the risks or complications of a spinal cord stimulator? 
• Painful battery/connection site. If this is severe, further surgery or removal of the system may be advised.
• Infection (less than 5 in 100 people). If this happens, the whole system may need to be removed.
• Bleeding, which may lead to bruising and in rare cases may require further surgery.
• Severe headache, which may require treatment with a spinal injection if it does not improve within days.
• The leads may move or not work. This may need another operation to correct.
• Unpleasant stimulation, which may not respond to stimulation adjustment and may require stimulation to be abandoned.
• Stimulation felt outside of the painful area is common, but only a problem if unpleasant
• Failure to capture the area of pain, or no pain relief, which may lead to consideration of revision surgery to re-site the leads or remove the system.
• Allergic reaction leading to removal of the system.
• Decrease in pain relief with time.
• Nerve damage leading to nerve pain, numbness and weakness. This may be temporary or permanent.
• Paralysis. This is extremely rare (two patients in one million). 

In order to be considered for spinal cord stimulation you must (be eighteen years of age or older) have been diagnosed with one of the following conditions, as per NICE guidelines:

• failed back surgery syndrome (FBSS)
• complex regional pain syndrome (CRPS)
• neuropathic pain (NP)
• Buerger disease
• have moderate to severe chronic pain measuring greater than five
• have tried and not responded to conservative treatments
• be willing to stop or reduce excessive medication, and use pain
• be able to manage the technical demands of the equipment. 

A trial of spinal cord stimulation is carried out before considering a permanent implant because the effectiveness of spinal cord stimulation varies from patient to patient. The trial is normally performed as a day case procedure at Hospital.

You will receive local anaesthetic and sedation, and stimulation leads are carefully sited in the epidural space within the spine. The leads are then attached to an external hand held controller which allows you to control the stimulation. Occasionally, if you have other medical conditions, you will need to stay in hospital overnight.

We like you to have a trial for seven to 15 days at home. This is the best way to assess how effective the stimulator is for you. We look at your pain score, your activity, your medication use and your sleep pattern. You will return to the neurosurgeon at the end of the trial for assessment. It is important that you contact us if you have any concerns or problems during the trial. If the trial is unsuccessful, we will organise a further follow up, or discharge you back to the care of your local pain clinic. 

If the trial is successful, you will require another procedure for a full implant. The first stage of this procedure is placement, or fixation, of the stimulating lead in the spine, similar to the trial. The second stage of the permanent implant involves inserting the battery – this is performed under deep sedation or general anaesthetic. The battery placement is discussed with you before the procedure. A small incision in your skin is required to place the battery either in your buttock or abdomen. You will need to stay in hospital, normally for one night. 

The aims of the pre-implant programme are to increase the effectiveness of spinal cord stimulation treatment provide information on the procedure and potential risks and benefits increase the understanding of chronic pain provide individual medication advice work on maximising your physical fitness and function 4 of 6 help you to work towards realistic goals maximise psychological well being, flexibility and vitality help you to meet other patients who have similar experiences provide support in decision making and help you to give informed consent for any future procedure.