Second video in our series about pain management during the coronavirus (COVID-19) pandemic
Spinal Cord Stimulation (SCS) is a particularly appealing option for those with chronic who are hoping to avoid surgery. The field of Neuromodulation (aka neuroaugmentation, aka neurostimulation) was born from the need to find an alternative to surgery. SCS adheres to the fundamental principles of Minimally Invasive Surgery (MIS) by avoiding the excessive tissue injury and scarring inherent to open surgery. The important thing to remember is a SCS trial is not surgery, in fact there is no cutting of any kind. Patients get to test out the neurostimulation in a fully reversible fashion to see if it works and is effective in treating their specific pain complaints.
Everyone’s pain is different and no two person’s complaints are the same. This may explain why spinal surgery is successful in some (61%) yet in others their pain is made worse – the approach and treatment of the procedure itself is virtually identical, regardless of any nuances in their pain complaints. SCS is truly customizable to each person’s particular complaints, no matter how subtle the variation.
When compared to conventional open surgery as a treatment for neck or low back pain, SCS has considerable advantages:
|Spinal Cord Stimulator Trial||Open Spinal Surgery|
|Outpatient procedure and can be performed right in the your doctor’s office||Performed in the hospital
|Depending on your insurance, may require as little as an office visit copay||Can be very expensive when considering co-insurance likely due to the physician, anesthesiologist and the hospital|
|Takes less than an hour, start-to-finish||Takes several hours with considerable post-operative pain|
|Virtually no recovery time||Long recovery time|
|Go back to work the next day||May be weeks before returning to work|
|No post-operative rehab or physical therapy during the trial||Several months of physical therapy|
|Can be performed under local anesthetic||Performed under general anesthesia and requires intubation|
|Low risk profile||High risk profile|
|Reversible||Irreversible and considerable chance pain could get worse|
The only similarity between SCS and TENS is that both use electrical signals to control pain (Gate Control Theory). TENS is vastly inferior to Spinal Cord Stimulation due to a number of limitations.
|Spinal Cord Stimulation||TENS|
|Under the skin||Outside the skin|
|Signal transmitted directly at the level of the spinal cord and not dependent on tissue depth||Weaker signal and gets weaker traveling through the skin and all the underlying tissue|
|No regular maintenance except for recharging||Requires constant maintenance; needs to be put on and taken off daily|
|Battery replaced once every 10 years approximately*||Pads need to be constantly reordered which can be costly|
|Once implanted, nothing is external – everything is located under the skin||Bulky external device|
|Can control pain in multiple areas at once without needing the leads to be moved||Cannot treat sciatica - can only control pain the area where the pads are located|
|Can be constantly changed and customized (even after implantation) through a wireless signal between the device and an external, handheld programming remote without ever having to remote the SCS||Limited customization|
 Turner JA, Herron J, Hasselkorn J, et al. Patient outcomes after spine fusion. JAMA 1992;268:907-911.