What is Spinal Cord Stimulator Implant

Spinal cord stimulator is a small device that makes electrical signals and sends them through wires (leads) to nerves in the spinal cord. This stimulates the nerves and can help relieve long-term (chronic) pain in the back, legs, or arms. Implantation is a procedure to place this device under the skin.

This procedure is done if a temporary spinal cord stimulator effectively reduces your pain during a trial period.

A spinal cord stimulator may have an electrical pulse generator, a battery, and leads. It may also come with a small remote that you can control.

Stimulators with a rechargeable battery may last up to 10 years. Stimulators with a non-rechargeable battery may last 2–5 years before being replaced.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines, devices, or dyes.
• Damage to the skin where the battery is placed, or damage to nerves, back muscles, or the spinal cord.
• The device or battery failing or not working.
• A lead moving out of place.
• Inability to move (paralysis).
• A pocket of clear fluid forming under the skin (seroma).
• Spinal fluid leakage.
• Numbness.
• Inability to control when you urinate or have a bowel movement (incontinence).

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
  • Taking over-the-counter medicines, vitamins, herbs, and supplements.

General instructions

• You may be asked to shower with a germ-killing soap.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• You will have blood tests and physical exams.
• You may have chest X-rays.
• You will have an electrocardiogram (ECG) to check the electrical patterns and rhythms of your heart.
• Plan to have someone take you home from the hospital or clinic.
• Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.
• Ask your health care provider what steps will be taken to help prevent infection. These may include:
  • Removing hair at the surgery site.
  • Washing skin with a germ-killing soap.
  • Antibiotic medicine.

What happens during the procedure?

• An IV will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to numb the area (local anesthetic).
  • A medicine to make you fall asleep (general anesthetic).
• Dye may be injected into your spinal canal (epidural space) to make it easier to see on X-rays. X-rays may be done during the procedure to help implant the stimulator.
• A small incision will be made in your back.
• A small piece of bone may be removed from your spine to make room for the device.
• Leads will be placed near your spinal cord. X-rays may be done to make sure they are in the right place.
• The leads will be tested with stimulation, and you will be asked to react to the tests. If you are under general anesthetic, you will be woken up for this part, and then given more medicine to make you fall asleep again.
• The leads will all be joined to one lead that connects to the pulse generator (lead wire).
• The lead wire will be placed under your skin so that it leads from your spine to your abdomen or buttocks.
• A small incision will be made in your abdomen or buttocks.
• The pulse generator will be placed in either your abdomen or buttocks and connected to the lead wire. A small pocket of skin will be formed around it.
• Your incisions will be closed with stitches (sutures).
• Your incisions will be covered with bandages (dressings).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until you leave the hospital or clinic.
• You will be given pain medicine as needed.
• You will have to drink fluids.
• Your pulse generator may be programmed.
• Do not drive until your health care provider approves.
• You may have to stay in the hospital after the procedure. Ask your health care provider how long you will stay.

Summary

• A spinal cord stimulator sends electrical pulses through the leads to the spinal cord. This can relieve pain.
• A spinal cord stimulator may have an electrical pulse generator, a battery, and a small remote that you can control.
• Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic.

Spinal Cord Stimulator Implant, Care After

Here is the information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Mild pain, bruising, and swelling.
• Headaches.
• Soreness in the back.

Follow these instructions at home:

Incision care

• Follow instructions from your health care provider about how to take care of your incisions. Make sure you:
  • Wash your hands with soap and water before you change your bandages (dressings). If soap and water are not available, use hand sanitizer.
  • Change your dressings as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision areas every day for signs of infection. Check for:
  • Redness, more swelling, or more pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Activity

• Ask your health care provider what activities are safe for you during recovery. Do not do any of the following until your health care provider approves:
  • Drive.
  • Activity that requires a lot of energy, including exercise and sports.
  • Lift anything that is heavier than 5 lb (2.3 kg), or the limit that you are told.
  • Engage in sexual activity.
  • Lift your arms above your head.
  • Sleep on your stomach, if your device was placed in your abdomen.
  • Bend, twist, stretch, or reach for things.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths.

Safety

• Devices that sends out wireless signals may affect your stimulator. If directed by your health care provider, avoid the following:
  • MRI and ultrasound tests.
  • Metal detectors.
  • Anti-theft devices.
  • Generators or power lines.
• Always carry your device ID card with you.
• Tell all health care providers who care for you that you have a spinal cord stimulator. This is important information that could affect the medical treatment that you receive.

General instructions

• Work with your health care provider to adjust your settings as needed for pain control. Adjusting settings may take some time. Most stimulators can be controlled with a remote.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Drink enough fluid to keep your urine pale yellow.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if you have:

• A fever.
• Severe pain, and medicines do not help.
• More fluid or blood coming from your incisions.
• Headaches that do not go away.

Get help right away if:

• You have redness, more swelling, or more pain around your incisions.
• Your incision area feels warm to the touch.
• You have pus or a bad smell coming from your incision area.
• You have chest pain or problems breathing.
• You have sudden and severe back pain.
• You have weakness or sudden muscle tightening (spasms) in your legs.
• You are not able to control when you urinate or have a bowel movement (incontinence).

Summary

• After implantation of a spinal cord stimulator, mild pain, muscle soreness, headaches, and bruising are common.
• Follow instructions from your health care provider about incision care, bathing, medicines, and activity.
• Work with your health care provider to adjust your settings as needed for pain control. Adjusting settings may take some time. Most stimulators can be controlled with a remote.