High-Tech Solution for Chronic Pain: Spinal Cord Stimulation

Spinal cord stimulation is an advanced medical device that controls severe pain unresponsive to medications and physical therapy by sending mild electrical currents to the spinal cord. By blocking pain signals from reaching the brain, this system significantly improves patients' quality of life. It offers a highly effective option, especially for those searching for a treatment for persistent back pain and struggling with daily activities.

• Spinal cord stimulation uses a device that intercepts pain signals before they reach the brain.
• It is particularly preferred for persistent pain following failed back surgery.
• A temporary trial period is always conducted before the permanent device is implanted.
• The surgery is usually performed under local anaesthesia or mild sedation.
• The system is completely reversible; it can be removed from the body if desired.
• The goal is not to eliminate pain entirely, but to reduce it by 50 to 70 percent.

What is Spinal Cord Stimulation?

Revolutionising the field of chronic pain treatment, spinal cord stimulation is a neuromodulation system that alters how the brain perceives pain signals. In the human body, pain travels through nerves to the spinal cord and then to the brain. This technology consists of a small generator, similar to a pacemaker, and thin electrode leads placed at the back of the spinal cord. The device sends very mild electrical signals to the nerve pathways leading to the painful area.

These signals replace the sensation of pain with a gentle tingling feeling or, in newer high-frequency devices, directly block the pain without creating any sensation at all. The system can be adjusted externally via a remote control based on the patient's pain intensity, posture, and daily activities. One of the greatest advantages of this treatment is that it does not cause permanent damage to the nerve pathways or the spinal cord. Because it is a reversible method, the system can be completely removed from the body if the patient wishes to switch to a different treatment in the future.

Who is a Candidate for Spinal Cord Stimulation?

Spinal cord stimulation is not applied as a first-line option for every patient with pain complaints. For this method to be considered, the patient must have tried all other traditional treatments—such as medication, physical therapy, injections, or surgery—for at least six months without success. The most common patient group for this treatment are those suffering from what is medically known as failed back surgery syndrome, where individuals continue to experience pain despite having undergone one or more herniated disc or spine surgeries.

In addition, this method is highly effective in cases of painful diabetic neuropathy, which develops due to diabetes and manifests as a burning or stinging sensation in the feet. Complex regional pain syndrome, persistent neuropathic pain due to nerve injuries in the arms and legs, and ischemic limb pain caused by vascular occlusion are other areas where spinal cord stimulation is successfully used. The patient's psychological state is also evaluated when making the treatment decision, as chronic pain can lead to depression and anxiety disorders in the long term.

Pre-Treatment Evaluation Process

Before spinal cord stimulation surgery, patients must undergo a detailed medical evaluation. During this process, the patient's pain history, current medications, and previous surgeries are thoroughly reviewed. Blood tests, electrocardiography, and detailed spinal MRI scans are performed to check if the anatomical structure of the spinal cord is suitable for the implant. Furthermore, it is determined whether the patient is taking blood thinners, and these medications are safely adjusted prior to surgery.

As a standard procedure during this evaluation phase, the patient is also seen by psychiatry or psychology specialists. The extent of the psychological burden caused by chronic pain and the patient's capacity to adapt to the device are assessed. It is clearly explained to the patient that the device will not completely eliminate the pain, but rather aims to reduce it by 50 to 70 percent, allowing them to perform daily tasks independently. Following all these examinations, the temporary trial phase begins.

Surgery Process and Recovery

The Trial Phase (Temporary Implant)

Spinal cord stimulation treatment consists of a two-stage surgical process. The first stage, the temporary trial, is performed to determine if the patient will truly benefit from this treatment. Under local anaesthesia and mild sedation, a thin electrode is placed over the spinal cord lining using a special needle. This electrode is connected to a temporary battery located outside the body. The patient spends a few days at home (or at their accommodation in Türkiye) with this temporary system. If there is a significant reduction in the patient's pain during this trial period, the decision is made to implant the permanent device.

Implanting the Permanent Device

The second stage, the permanent spinal cord stimulation surgery, is usually performed under general anaesthesia or deep sedation. The electrodes placed on the spinal cord are connected via thin cables routed under the skin to the main generator, which is placed in a small pocket created subcutaneously in the buttock or abdominal area. The procedure takes an average of two to three hours. After the surgery, the initial settings of the device are configured in the operating room or the patient's room, and the patient is taught in detail how to use their remote control.

Recovery Process

After the permanent device is implanted, patients are generally kept under observation in the hospital for one or two days. The first few weeks after discharge are a highly sensitive period for the electrodes to fully anchor in their places on the spinal cord. During this time, patients must strictly avoid sudden bending, twisting, stretching, and heavy lifting. Keeping the incision sites clean and dry is vital to minimise the risk of infection. Following a period of about six to eight weeks, patients can return to their normal lives with their doctor's approval.

Complications and Possible Risks

As with any surgical intervention, spinal cord stimulation surgery carries certain risks. The most common complication is the displacement or migration of the electrodes on the spinal cord. This situation causes a change in the direction of the impulses sent to the area where the patient feels pain and usually requires a minor surgical correction. To prevent this, it is essential to strictly adhere to the movement restrictions during the first few weeks.

Other possible risks include infection at the incision site, bleeding under the skin, cerebrospinal fluid leakage, and tenderness at the battery site. In rare cases, technical issues such as hardware failure or cable breakage may occur. The risk of nerve damage in the spinal cord is extremely low. Having uncontrolled diabetes is among the main factors that increase the risk of postoperative infection.

When to See a Doctor?

Certain symptoms during the postoperative period may require urgent medical attention. You should contact your doctor without delay if you experience any of the following:

• Increasing redness, swelling, warmth, or purulent discharge at the incision site.
• A persistent fever of 38 degrees Celsius or higher.
• Sudden and severe pain in the area where the battery is implanted.
• A sudden return of your previous pain at the same intensity, even though the device is turned on.
• Feeling the electrical impulses in different and unwanted parts of the body.

If you develop serious neurological symptoms such as sudden loss of strength, numbness, tingling in your legs or arms, or loss of bowel or bladder control, you should immediately call 112 or visit the emergency department of the nearest fully equipped hospital.

The Process at BHT CLINIC

If you are struggling with persistent pain, personalised treatment plans are created for you at the fully equipped Neurosurgery department of BHT CLINIC Tema Hospital. Assoc. Prof. Dr. Mustafa Kılıç and our expert team aim to improve our patients' quality of life by utilising the latest neuromodulation technologies. Your journey begins with a detailed examination and radiological evaluation.

In addition to spinal cord stimulation surgeries, non-surgical methods such as Radiofrequency Therapy are also successfully applied to suitable patients at our hospital. You can also receive support from our Dermatology department for postoperative scar care or other skin sensitivities. For our patients who are scheduled for surgery, every step from the trial phase to the implantation of the permanent device is meticulously planned. Our 24/7 emergency department is always ready for any unexpected situations. To break free from the pain that restricts your life, you can book an appointment with our physicians.

Frequently Asked Questions

How long does spinal cord stimulation surgery take?

The temporary trial procedure takes about 30 to 45 minutes, while the surgery to implant the permanent spinal cord stimulator takes an average of 2 to 3 hours. The duration of the surgery may vary depending on the patient's anatomical structure and the number of electrodes to be placed.

Does spinal cord stimulation completely eliminate pain?

The main goal of this treatment is not to completely eliminate pain, but to reduce it by 50 to 70 percent, a level that will significantly improve the patient's quality of life. This reduction is often enough for many patients to perform their daily tasks, sleep comfortably, and largely discontinue their pain medications.

Can I have an MRI with a spinal cord stimulator?

Most of the new generation spinal cord stimulators are manufactured to be MRI-compatible. However, before an MRI scan, the device must be put into a special MRI mode or turned off completely. You must inform the radiologist and your doctor about the brand and model of your device before the scan.

How long is the battery life, and what happens when it runs out?

The lifespan of non-rechargeable batteries generally ranges from 3 to 7 years, depending on the frequency of use. Rechargeable systems can last up to 10 years. When the battery life ends, the electrodes are left in place, and only the subcutaneous battery is replaced with a new one through a minor local operation.

Is the device visible from the outside?

The permanent device (generator) is placed under the skin, usually within the fatty tissue in the abdominal or buttock area. From the outside, there is no noticeable swelling or scar; patients can comfortably wear tight clothing or go swimming.

This article is for informational purposes only; please consult your physician for diagnosis and treatment.