The Best Spinal Cord Stimulators? [Reviews, Problems, Benefits]

Would You Benefit From A Spinal Cord Stimulator?

What is a spinal cord stimulator?

• A spinal cord stimulator is a medical device that a healthcare provider can implant in your body to treat severe pain.
• These devices come in several types and can be an alternative to other forms of treatment, such as opioids, which may become addictive.

How does a spinal cord stimulator treat pain?

• To understand how a spinal cord stimulator works, it helps to know a little about how pain and your nervous system work.

Is it normal to have chronic pain?

• Under ordinary circumstances, pain is a protective process. It tells you when you’re hurt or if something is happening to your body about to break you. It’s also a key sign of many illnesses and diseases.
• However, pain isn’t always protective. Many conditions cause overwhelmingly severe pain that doesn’t let up or go away. That can make it hard to sleep or work. Over time, living with chronic (long-term) pain can have serious — or even severe — consequences.
• Chronic pain causes changes in your brain and nervous system. Those changes can make pain feel more severe (hyperalgesia) or cause your nervous system to send pain signals for things that shouldn’t hurt (allodynia). Sometimes, your nervous system may send pain signals randomly or constantly.

How do your nerves work?

• Your nervous system forms an intricate network throughout your body, providing two-way communication between your brain and different body parts. Think of your nervous system like a phone line and pain signals like phone calls.
• Spinal cord stimulation (another term for this is neuromodulation) uses a mild electrical current to stimulate specific nerve fibers in your spinal cord. In effect, that current acts like another call are using the phone line, which keeps pain signals from reaching your brain.

Who benefits most from a spinal cord stimulator?

• Spinal cord stimulation treats chronic, severe pain. It’s usually an option when other means of controlling pain are unsuccessful.
• The conditions and circumstances that result in needing a spinal cord stimulator are most common in adults.
• However, adolescents and teenagers may also have requirements that are treatable with spinal cord stimulation.

What conditions does spinal cord stimulation treat or manage?

           Chronic pain can happen for many reasons, but some are more likely than others. Potential reasons include:

1. Back pain.
2. Complex regional pain syndrome (CRPS).
3. Continued back pain after laminectomy surgery. Previously known as “failed back surgery syndrome,” experts now often refer to this as a post-laminectomy syndrome or persistent spinal pain syndrome (PSPS).
4. Diabetes-related neuropathy (nerve damage).
5. Pain that happens because of malfunctions in your nerves (neuropathic pain).
6. Researchers are also investigating if spinal cord stimulation can help people with the following:
7. Central pain syndrome, heterotopic ossification (bony tissue developing inside soft tissues).
8. Ischemic pain (this happens because of low blood flow).
9. Chest pain (angina) that isn’t controllable through other means.
10. Spinal cord injuries and other types of nerve injuries.
11. Postherpetic neuralgia (nerve pain caused by damage from shingles).
12. Researchers are also considering other conditions that may benefit from spinal cord stimulation. Some examples of these conditions include cerebral palsy and traumatic brain injuries. However, more research is necessary to determine whether spinal cord stimulation is effective for those conditions.

How common or frequent are these procedures?

• More than 30,000 people annually undergo surgery to implant a spinal cord stimulator.

How does the Nevro Implant Procedure Take Place?

What happens before this procedure?

• Spinal cord stimulation isn’t a first-line procedure.
• That means it’s an option when other treatments don’t work, such as physical therapy and medication injections.
• Before you can have this surgery, you’ll undergo lab, imaging, and diagnostic tests to ensure you’re healthy enough for surgery and to rule out any other circumstances that might mean you shouldn’t have this procedure.

You’ll also need to see several healthcare providers and specialists before undergoing this surgery. The specialists typically include:

1. A neurologist. These physicians specialize in conditions affecting your brain and nervous system. These providers often diagnose the pain-related condition that causes you to need spinal cord stimulation.
2. A pain management specialist. These specialist physicians determine if less-invasive treatments haven’t treated the problem or if there’s another reason why you can’t receive or undergo those treatments.
3. A neurosurgeon. This provider can do the surgery to implant the spinal cord stimulator. In some cases, this is a physician you’ve already seen for other treatments to help your pain condition.
4. A psychiatrist or psychologist. These mental health providers can evaluate your mental health and any related conditions you might have. Chronic pain can severely affect your mental health, causing conditions — such as anxiety and depression — that also need treatment. Some mental health conditions reduce the odds that spinal cord stimulation will work in the long run, so diagnosing and treating these conditions is also important.
   An anesthesiologist. This surgery involves general anesthesia, so an anesthesiologist must talk to you beforehand. They’ll also review your medical history for information or details that might change how general anesthesia affects you.

Tips To to Prepare for a Nevro Implant:

Once you’re cleared for surgery, you’ll receive information and guidance on how to prepare. This typically includes topics like the following:

Medications you take:

•  Tell your provider about your prescription, including vitamins and supplements.
• They may have you switch certain medications or stop others (such as blood thinners).
• After discussing them with your provider, it would be best to stop taking medicines.

Bathing and grooming:

• Your healthcare provider will likely give you instructions on bathing and preparing for the procedure.
• This commonly includes a particular type of soap or other hygiene products for your skin system.
• Because this surgery involves general anesthesia, your healthcare provider will have you fast.
• That means no solid food for at least eight hours before the procedure and no liquids for at least two hours.

What happens during spinal cord stimulation?

• Spinal cord stimulator implantation is a process that usually involves two procedures.
• The first is a “trial” procedure.
• If the trial succeeds, the second will involve the entire surgery to implant the pulse generator or battery.

What does the spinal cord stimulator procedure involve?

•  A spinal cord stimulator involves attaching one or more electrical leads (insulated wires or small, flat panels with conductive contacts near the tip).
• The leads connect to a pulse generator, which generates the electrical current that will stimulate the spinal cord.
• The conductive parts of charges go into the epidural space between the dura mater (the outer membrane surrounding the spinal cord itself) and the ligaments inside your spine.

           The location of the leads on your spinal cord can vary. For most people, the best place is in your back at about the same level as the lower edge of your breastbone (sternum).

           For those with pain in the arm, the neck may be a possible option for placement.

A 7 Day Nevro HFx Trial Procedure:

           The trial procedure generally involves a percutaneous (meaning “through the skin”) approach. During this procedure, you’re usually under sedation (light sleep). You might receive general anesthesia under certain circumstances, but this is less common. They’ll also use a particular type of x-ray called fluoroscopy (the real-time video equivalent of an x-ray), which lets them see where to place the lead.

           After you’re under sedation or anesthesia, your provider makes a small incision (cut) in your skin and inserts a special needle through and into your back.

          Once the needle tip reaches epidural space, your provider will thread the temporary lead(s) into position and remove the needle, leaving part of the lead outside your skin.

           Once the leads are in place, your provider will secure the outer end of the information to your skin and connect it to a pulse generator, also attached to your skin (attaching the data and the external generator can use a suture or skin glue).

Does the stimulator work for a week?

           They’ll then program and start testing to see whether or not the stimulator works without having to do a complete surgery.

           These trials typically last a few days to a few weeks (this varies in different parts of the world).

           Your provider will remove these leads at the end of the trial. Experts consider a stimulator trial successful if you have at least a 50% decrease in pain level. If the problem is successful, most people undergo the next step, implantation surgery, about a week or two after the trial procedure.

           If a percutaneous electrode isn’t possible, your provider may recommend placing a paddle electrode instead. This wider electrode requires additional surgery to make room for it.

           If you have a paddle electrode implanted, you must stay overnight in the hospital.

Long-Term Nevro Implant Procedure:

           During this sedation (twilight) anesthesia procedure, your provider will perform a procedure to place permanent leads in the exact location of the trial. That starts with an incision (cut) over your spine. 

           They won’t need to create that space if they place a percutaneous electrode.

           Once they place the leads, they’ll anchor the electrode end of the stimulator into place and thread the near future under your skin to where they’ll implant the pulse generator.

           They’ll then create a small, pocket-like space to plant the pulse generator.

Where is the spinal cord stimulator placed on your body?

           Where they implant the pulse generator depends on a few factors. They’ll usually place the generator just above or below belt level on the side that’s easiest for you to reach (either on the belly side or in one of your buttocks).

           They may also put it on the opposite side of whichever side is your preference for sleeping. It can always be adjusted in the future.

           Reaching the skin over the top of the pulse generator is essential, depending on which type of generator you have implanted.

           Some pulse generators are constantly active. Others need switching off, and on, which you do with a remote you hold next to the generator. The Nevro device even has a remote control to make the function easy as possible.

           There are also rechargeable generators, which you charge by having a unique device above or against the skin just over the generator.

           Programming the generator can happen in the procedure suite or the recovery room. Once your provider finishes implanting the generator, they’ll use sutures and staples to close the incisions.

           Doctors can also make adjustments to the programming at follow-up appointments.

What happens after the spinal cord stimulator procedure?

           After the trial procedure, you’ll likely be able to go home that same day or the following day. After the generator implantation surgery, most people can go home within one or two days.

           Your healthcare provider will guide you on caring for the procedure site after the trial lead placement and the generator implantation.

           In most cases, that involves caring for the surgical wound, keeping it clean, and changing its bandages for seven to 10 days.

           You’ll have a follow-up appointment about 10 to 14 days after the generator implantation surgery, where your provider will remove the staples and stitches.

Risks vs. Benefits of the Nevro HFx Implant:

What are the advantages of this procedure?

Spinal cord stimulation is a procedure that has many potential advantages:

1. It can treat pain that resists other forms of treatment.
2. Spinal cord stimulation is mainly used as an alternative when other methods don’t work.
3. It can treat many different types of pain.
4. The potential uses for spinal cord stimulation include heart-related chest pain, nerve pain, and spine or back pain.
5. It can help a person rely less on stronger pain medications. Opioid-based painkillers are often necessary for chronic pain. Unfortunately, these medications have many potential side effects and risks.
6. Spinal cord stimulation can reduce pain levels, which can help you reduce the dosage of your pain medications, how often you take them, or both.
7. The most common approach to spinal cord stimulation involves a trial period. You can try it temporarily before undergoing a long term procedure.
8. If the trial is unsuccessful, it’s typically reversible without surgery.

What are the risks or complications of spinal cord stimulation?

           Spinal cord surgery isn’t a first-line treatment because of potential complications and risks. These include:

1. Risk of infection: One of the most common — and most serious — risks with spinal cord stimulation devices is disease risk. That risk exists because spinal cord stimulation involves placing a device inside your body. If you get an infection around the implanted hardware, you may need surgery to treat the disease. Sometimes, treatment isn’t enough, and you need surgery to remove the generator and leads entirely.
2. Leads are moving out of position: This is less common than in years past due to medical technology and procedures advances. Special devices and components can anchor spinal cord stimulation leads, reducing the risk of them moving out of place.
3. Leads breaking or malfunctioning. Your spine is a column of interlocking bones known as vertebrae (the term for one is “vertebra”). The vertebrae and their related connective tissues (ligaments and muscles) can flex and bend. In some cases, the hardware of the leads can’t match that flexibility, causing the authorities to break or malfunction. That usually requires surgery to correct.
4. Injuries from broken or displaced leads: When the hardware involved in spinal cord stimulation breaks or moves out of place, it can sometimes damage your spinal cord or the surrounding tissues. In severe cases, that can permanently damage your spinal cord or nearby nerves. Fortunately, permanent injuries are rare.
5. Pulse generator malfunction or failure: Spinal cord stimulation relies on a pulse generator with a lifespan. Pulse generator batteries typically need replacement after several years. The generators can also fail, and repairing or replacing them involves surgery.
6. Gradual loss of pain relief: Possible side effects, depending on the stimulator type and location. An example of this is how some stimulators deliberately cause a feeling of tingling or numbness. While that isn’t pain, it may also feel uncomfortable or unpleasant to some people.

What are the spinal cord stimulator permanent restrictions?

After the implantation of a spinal cord stimulator (SCS), patients may need to follow certain permanent restrictions or precautions to ensure their safety and the device’s proper functioning. Some of the most common permanent restrictions include:

1. MRI scans: Many SCS devices are MRI-conditional, which means they are safe for MRI scans only under specific conditions. Note: this does not apply to the Nevro implants but can to some of the other devices we mention here. Patients with an SCS implant should always inform their healthcare provider and MRI technician about their device and follow the manufacturer’s guidelines for MRI scans.
2. Diathermy: Diathermy, a medical procedure that uses high-frequency electromagnetic energy to generate heat, is typically not recommended for patients with an SCS implant, as it may cause damage to the device or injure the patient.
3. Electrocautery: Some SCS systems may be sensitive to electrocautery, a surgical technique that uses an electric current to control bleeding or remove tissue. Patients with an SCS implant should inform their healthcare provider about their device before undergoing electrocautery surgical procedures.
4. High-voltage electrical equipment: Patients with an SCS implant should avoid close proximity to high-voltage electrical equipment, such as power lines, transformers, or transmitting antennas, as these can potentially interfere with the proper functioning of the device.
5. Security and theft detection systems: Patients should know that their SCS implant may trigger security alarms or theft detection systems.Note: the Nevro implant can still pass through the scanning devices at airports. But people should carry the device manufacturer’s identification card to inform security personnel about their implant.
6. Strenuous physical activities: While most patients can resume their normal daily activities after the implantation surgery, some restrictions may apply to high-impact or strenuous physical activities. Healthcare providers may advise patients to avoid certain activities that could strain the implant site excessively or cause the leads to move or dislodge.

         These are some general permanent restrictions patients with an SCS implant may need to follow. However, individual restrictions and precautions may vary depending on the device, the patient’s condition, and the healthcare provider’s recommendations. It’s essential to consult with a healthcare professional to discuss the appropriate precautions for your specific SCS implant and situation.

Recovery Time for Spinal Cord Stimulator Implant Surgery:

What is the surgery recovery time?

You can usually return home the same day or the day after you undergo the implantation of trial stimulator leads.

• Your healthcare provider will likely recommend that you take it easy and avoid bending, stretching, lifting, and other forms of physical activity while you get used to the stimulator leads and their effects.
•  The generator implantation surgery is more involved, so you’ll need more time to recover.
• You can usually go home the following day after the surgery, but your healthcare provider will have you limit your physical activity for several weeks (usually four to six weeks).
• That will allow the pocket around the implanted generator to heal and your body to get used to the stimulation leads.
• Your healthcare provider is the best person to give you information and guidance about the recovery time and how to best care for yourself after this procedure.
• They can provide you with relevant and essential information for your situation.

When To Call Your Doctor:

          Your healthcare provider will schedule follow-up visits after you undergo the generator implantation surgery.

• You should see them as recommended for these visits, which can help with adjustments to the electrical stimulation your device delivers.
• You should also call or see your healthcare provider if you notice any increases in your pain levels or any gradual increase in side effects.

Some of the possible complications include the following:

1. Headache: that’s constant when you stand or sit up but goes away when you lie down. This can be a symptom of a cerebrospinal fluid (CSF) leak, which can happen if a lead damages the dura mater and allows CSF to leak out.
2. Signs of infection around surgical sites: These include redness, swelling, pain, and an oozing (and sometimes foul-smelling) discharge.
   You should seek emergency medical attention right away if you notice any of the following:
3. The sudden appearance of numbness, tingling, or muscle weakness. This is a possible sign of a shift in the charge (s) position, which can damage the spinal cord or nearby nerves. This can affect one or both sides of your body anywhere below the location of the lead(s).
4. Some tingling is normal with specific stimulators, so it’s a good idea to ask your provider for guidance on which sensations are typical or expected and which are potential warning signs.
5. Any of the symptoms of sepsis. This is when a widespread infection in your body triggers a massive, life-threatening immune reaction. Sepsis is a medical emergency and can cause permanent damage or death without immediate treatment.