The spinal cord stimulation is a system that prevents the patient from feeling pain by stimulating a very thin electrode placed behind the spinal cord. It is especially applied to patients with chronic pain who have had surgery but whose pain persists. It can also be applied to patients who have pain in the legs after spinal cord injury.
Is it possible to eliminate the pain completely or does it only reduce the severity of the pain? The pain is completely eliminated in some patients, while it is reduced in some patients. The goal is to reduce pain by at least 50% with a pain pacemaker.
Spinal cord stimulation can be applied in two ways. The first method is to place the electrode on the spinal cord by entering the gap between the spine, which we call epidural space, with the help of a very fine needle with local anesthesia. It is a short process and the patient does not feel much pain during the process. The advantages of this process are that there is no need for general anesthesia, that the pain area is fully covered by instantly talking to the patient and thus providing the best pain relief. It is generally not suitable for patients who were operated on their upper back, such as scoliosis patients. It can be applied to patients who have undergone surgery at lower levels at the waist. The second method is entering through a small cut under general anesthesia and to place the electrode directly on the spinal cord by surgery. In both methods, the other ends of the placed electrodes are taken out of the body and connected to the test battery. The test period usually lasts for several weeks. If the patient is satisfied during the test period, a permanent battery is placed under the skin with a small operation.
Two types of battery can be implanted into the patient: regular battery or rechargeable battery. If a rechargeable battery is implanted, it is necessary to charge the battery from the outside with the wireless system at regular intervals. The regular battery lasts for 4-5 years, while rechargeable pacemakers last for 8-9 years, although it varies from patient to patient. When the battery reaches the end of its life, it is replaced with a new battery.
Spinal Cord Stimulation is a method used as a last resort in patients who experience pain. For this reason, it is not suitable for a herniated disc patient who has never undergone surgery. The most important application criterion is the pain caused by the nerve’s own damage, which is called neuropathic pain. Patients who have undergone lower back surgery, who do not have postoperative nerve compression, but whose pain persists, are suitable for spinal cord stimulation. If the patient has a lower back problem that can be corrected with surgery, it is not suitable to insert a pain pacemaker. First attempt should be at surgical treatment. If there is no benefit for the patient with surgery, drug therapy, physical therapy and if necessary, algological attempts we call epidural injections should be tried first. If no treatment method works out, then it may be decided to resort to spinal cord stimulation treatment.
Patients who are candidates for a spinal cord stimulation are usually those who have been living with painkillers for a long time. Continuous use of painkillers can damage our body. The main goal for implanting spinal cord stimulation is to minimize the patient’s drug dependence or, if possible, to stop it altogether.
Spinal cord stimulation is implanted first in the patients who are found eligible for the pain pacemaker. During the trial period, only the electrode is present in the patient’s body. The testing battery is located outside the body. The electrodes are easily removed if there is no sufficient reduction in the patient’s pain during the battery testing period or if the patient is not satisfied with the process. If the patient feels discomfort and is not satisfied with the permanent pacemaker, the system can be completely removed under local anesthesia with a short procedure.
Applications in Turkey are quite successful. It is very relieving for both the patient and the physician to see that the patient’s pain is gone and that their faces are smiling after the application of spinal cord stimulation for patients who have been in pain for a long time despite having tried all treatment methods available. The most important factor for success is that the patient and the doctor fight the pain together. In our country, patients know about spinal cord stimulation, but it is still important to raise public awareness about spinal cord stimulation.
It is a widely used method in the world. It is used especially in the United States and in the European Union within the framework of certain rules, as is the case for our country.
