Failed Back Surgery Syndrome
Dorsal Column Stimulator Implantation
Neuromodulation in the spine is more commonly referred to as spinal cord stimulation or dorsal column stimulation. It involves the implantation of a small device that sends mild electrical pulses through wires (called “leads”) to specific parts of the spinal cords. These pulses mask the pain signals that are traveling to the brain.
Implantation of a spinal cord stimulator is usually a two-step process. The first step is undergoing a trial period. In this step, under local anesthesia and x-ray guidance, electrical leads are inserted close to the spinal cord. These leads are then attached to an external stimulator. Over the next week, the patient is able to adjust the intensity and duration of the stimulation, as well as power it on or off. If the trial stimulation is effective in alleviating pain symptoms, a more permanent implantation of the device and battery can occur. This next step is often performed under IV sedation, and it sometimes involves the removal of small portion of the vertebra (the lamina) to make room for the stimulator leads. A small incision is then made either in the abdomen or upper buttocks for the battery-operated generator to be implanted. Patients normally get discharged either the same day or the next day. Just like during the trial period, through a hand-held device, patients are able to control the intensity of the stimulation, as well as power it on or off.
Spinal Cord Stimulation
Treatment of pain that persists after spinal surgery usually begins with non-operative techniques, such as physical therapy, oral anti-inflammatory medications, or steroid injections. If these measures fail, and there are no other clear identifiable causes of the pain, then neuromodulation may be a beneficial option. The concept of neuromodulation is to block pain impulses that are traveling from nerves to the brain. In regards to neuromodulation in the spine, a stimulator is used to send mild electrical signals to a specific part of the spine, which ultimately masks the pain signals.
Failed Back Surgery Syndrome
Failed Back Surgery Syndrome refers to chronic back pain that occurs greater than six months after a spine surgery. In other words, it’s when a spine surgery does not achieve its desired effect. There are multiple causes, some of which include inadequate diagnosis prior to the initial surgery, recurrent disc herniations, scar tissue around nerves, muscle deconditioning, or the progression of disease at levels adjacent to those operated on. It is reported that up to 20-40% of patients will experience Failed Back Surgery Syndrome.
Symptoms include persistent back pain that may radiate into the buttocks or hip, or even legs. The pain can range from being dull, achy to sharp or burning and can be extremely debilitating and frustrating.
The Boston Scientific Precision Spectra™ Spinal Cord Stimulator System is an innovative device that has a number of features that makes it a popular choice by providers and patients. Most notably, it is the world’s first spinal cord stimulation system that has 32 contacts and 4 lead ports, which is a representation of the area of coverage of the spinal cord that the leads provide. This in double previous versions of spinal cord stimulators. By having 4 lead ports, this gives physicians increasing flexibility to adapt to changes in a patient’s pain pattern in the future. Furthermore, the LeadSyncTM Technology that this devices utilizes has the capability of redirecting the stimulation field, so in cases where the leads may migrate, or move, there is a greater chance than a patient may continue to have pain relief.