Jenny L. F. Andrus, MD
A Spinal Cord Stimulator (SCS) or Neuromodulator is an effective device used by Interventional Pain Management Physicians for treating intractable chronic pain that has not responded to other conventional treatments, including surgery. In my practice, I have witnessed first-hand just how miraculous the results can be for some chronic pain patients. These patients can either completely discontinue all pain medications or decrease their use, many are able to return to work full-time or part-time, and more importantly, they are able to enjoy their family and their lives again. What is it that helps some patients do so well with an SCS device and others not do so well? In this article, I am going to discuss the three factors which I believe give our practice an outstanding success rate with SCS implantation.
Patient Selection – In my opinion, this is the most crucial factor in whether a patient will succeed or not with a Spinal Cord Stimulator. At OSC (Orthopaedic & Spine Center), we carefully screen each patient before we move forward with a SCS trial, by getting to know them personally, having the patient complete a psychological evaluation, as well as looking at their treatment history carefully. We want to ensure that the patient has appropriate expectations of what SCS treatment will and will not provide and that the patient is willing to work to educate themselves on how to use the device appropriately.
A positive outlook and attitude are extremely important as the patient will undergo two procedures (one in-office procedure for the trial implantation and one outpatient procedure for the permanent implantation). There will be some discomfort and inconvenience as the patient adjusts to the device and a new and vastly different way of dealing with their chronic pain.
This treatment is not for everyone and as a physician, it is my responsibility to help patients understand all aspects of the treatment, the good and the negative. It takes patience and perseverance from the patient to get to a good outcome, and sometimes, patients are not willing to spend the time nor the effort to move forward with this therapy.
Trial Education – Once the patient has been approved for a trial implantation, the education process begins on how to use the SCS device so that the maximum pain relief potential is realized. This takes work, and trial and error on the part of the patient. They must take a leap of faith with the new device and try out all the settings to understand its capabilities and functionality. They also need to have a well-educated manufacturer’s representative, who is a great instructor, to guide them along the way and to help with troubleshooting, should the need arise. This is the second most important factor of SCS implantation success, as the trial will determine if the patient can achieve significant pain relief and permanent implantation is warranted.
Spine Surgeons – Last, but certainly not least, are the spine surgeons who will do the permanent implantation of the SCS device and battery in the patient. It is important that the surgeon has the skill and experience to complete the surgery safely and effectively, with minimal risk to the patient. At OSC, we have two Spine Fellowship-trained surgeons who have extensive experience in SCS implantation, with stellar outcomes and extremely low rates of infection and complications. That is a statistic worth talking about to our patients considering this procedure.