By Dr. Nirav K. Shah (left) and
Dr. Nazer H. Qureshi (right)
Princeton Brain and Spine
Board Certified Neurosurgeons
Princeton, Langhorne, Freehold, Flemington, and New Brunswick
SURGICAL PAIN MANAGEMENT
Pain can be debilitating. Chronic pain can affect your ability to do the things you love most such as playing golf on a sunny day, travelling with your family, or even watching the next Phillies game.
Sometimes conventional surgery fails to completely relieve pain and a patient will continue to have pain related to the spine such as pain in one’s back/neck and/or extremities. This is known as failed back syndrome. Patients often ask, “I have had spine surgery or I have had spinal fusion and I am still having quite a bit of discomfort. What are my options?”
Options after Failed Spine Surgery
One option is surgical pain management such as spinal cord stimulation. This is an option for patients who have tried conservative care such as physical therapy and medications. The patients have also had multiple spine surgeries including spinal fusion without resolution of his/her symptoms. Symptoms could include pain as well as associated numbness and tingling in the extremities. After these failed surgeries, an orthopedic surgeon or spine surgeon may be reluctant to perform additional surgery due to scar tissue formation. Therefor there are no surgical cures at the site of the previous spine surgeries. This is when a patient can be considered for spinal cord stimulation. Spinal cord stimulation studies have proven to reduce pain levels by at least fifty percent or greater.
What Is Spinal Cord Stimulation?
Simply put, an electrode is placed on the spinal cord to block the pain. There are a few steps that must occur prior to taking the patient to the operating room.
Steps for Placement of Spinal Cord Stimulator
- A neuropsychological evaluation is performed to see if the patient understands what the procedure entails and whether he/she will be able to tolerate the operation.
- A pain management physician will perform a spinal cord stimulator trial. For this, the physician will place a percutaneous lead placement. In other words, a stimulator placed in the spinal canal. The wires are then attached to a battery (pulse generator) which is then taped to the patient’s body. For the next three to five days, the patient must keep an active diary of how the pain is controlled with the spinal cord stimulator. After three to five days have passed, the patient will return to the pain management physician to discuss the next steps.
- If the trial is deemed successful by the pain management physician and patient, then the patient is referred to a neurosurgeon for further consultation regarding permanent implementation of the spinal cord stimulator. The neurosurgeon will make the final decision as to what the best course of action if for the patient.
The surgical procedure requires two incisions in the back. One is for the placement of the paddle lead and the other is on the patient’s side for placement of the implantable pulse generator. This procedure is done by a neurosurgeon and then the pain management physician will manage the device stimulation on a long-term basis.