Placing of Spinal Cord Stimulator in Paralyzed Patients

Placing a spinal cord stimulator (SCS) in paralyzed patients is a procedure that involves implanting an electrical device in the spinal canal to help manage pain or improve function. However, it’s important to note that spinal cord stimulation is typically not used in patients with complete paralysis (no motor or sensory function below the level of injury) since they would not benefit from the procedure.

Spinal cord stimulation is commonly used to treat chronic pain conditions, such as failed back surgery syndrome, complex regional pain syndrome (CRPS), and neuropathic pain. The goal of spinal cord stimulation is to provide pain relief by delivering low-level electrical impulses to the spinal cord, which can interfere with or modulate the transmission of pain signals to the brain.

The placement of a spinal cord stimulator involves the following steps:

1. Trial Period: Before the permanent implantation, a trial period is often performed to determine if the patient responds positively to the spinal cord stimulation. During the trial, temporary leads are placed through a needle into the epidural space near the spinal cord. The leads are connected to an external stimulator device that the patient can control to assess its effectiveness in managing their pain.
2. Surgical Implantation: If the trial period is successful and provides significant pain relief, the patient may undergo the surgical implantation of a permanent spinal cord stimulator system. This procedure is typically performed under general anesthesia. A small incision is made in the back, and the leads are inserted into the epidural space near the spinal cord. The leads are then connected to a pulse generator, which is usually implanted in the buttock or abdomen. The pulse generator generates the electrical impulses and can be programmed to meet the patient’s specific needs.
3. Programming and Adjustment: After the surgical implantation, the patient works closely with a healthcare professional, typically a pain management specialist, to program and adjust the settings of the spinal cord stimulator. The programming involves determining the appropriate level of stimulation, adjusting the frequency and intensity of the electrical impulses, and ensuring optimal pain relief and minimal side effects.

It’s important to note that spinal cord stimulation may not completely eliminate pain but can significantly reduce its severity and improve the patient’s overall quality of life. The effectiveness of spinal cord stimulation varies among individuals, and it may not be suitable for everyone.

Before considering spinal cord stimulation, it is crucial for paralyzed patients to consult with a pain management specialist or neurosurgeon experienced in spinal cord stimulation to determine whether they are suitable candidates for the procedure and to discuss the potential benefits and risks. Each case is unique, and an individualized approach is necessary to determine the most appropriate treatment options.