Spinal Cord Stimulator
A spinal cord stimulator is an electronic device that is implanted in the body to help relieve chronic pain. Also known as a dorsal column stimulator, the device sends low electrical currents through wires placed near the spinal cord to treat pain. It allows patients to control when pain relief is needed or not.
The device does not cure chronic pain, but usually provides a 50% or greater decrease in pain and allows patients to be more active and have less of a need for pain medication. This procedure is usually considered when other solutions, such as surgery, injections and medications, have failed. Before implantation, patients will often be asked to go through a trial period with an external device. The trial will test patients' pain levels and see if they increase with the help of the device.
During the implantation of the permanent device, wires are fed with a needle and positioned on the spinal cord. The actual device is placed dependent on where the pain is. The device can be removed if necessary. The battery of the device must be replaced every 2 to 5 years. Complications rarely occur as the procedure is very safe and minimally invasive. Proper care following the procedure is required and includes limiting movement and avoiding driving for the first few weeks.
Radiofrequency ablation (RFA), also called radiofrequency neurotomy is a procedure that involves heating a part of a pain-transmitting nerve with a radiofrequency needle to create a heat lesion. This resulting lesion prevents the nerve from sending pain signals to the brain. RFA treatment typically provides longer-lasting pain relief compared to other therapeutic injections. RFA is considered for treating facet joint pain in the cervical, thoracic, or lumbar spine; or for sacroiliac joint pain in the posterior pelvis.
Once the RFA lesion is created, the pain-transmitting ability of the nerve fibers is lost and pain signals from the source (facet or sacroiliac joint) do not reach the brain. The effects of RFA may last for a few months to years, after which the nerve usually regenerates, and the pain may or may not return.
Success usually depends on the accuracy of diagnosis, variations in the anatomy of the nerve, and the type of technique used. Pain-relief typically lasts from 6 months to 2 years, although some studies have reported relief for up to 3 years.
A common side effect of radiofrequency rhizotomy is that in the first few weeks or days, a sunburn type burning and or numbness may be felt over the injection site, typically for RFA performed in the neck. Resting, using an ice-pack, and using topical or oral medications may help relieve the discomfort. Risks, although rare, may involve infection, adjacent nerve damage, injury to blood vessels, and/or abnormal sensations in the skin over the treatment site.
A discography, also known as a discogram, is a diagnostic test performed to determine whether back pain is a result of certain spinal disc abnormalities.
The intervertebral discs are spongy pads of cartilage that offer cushioning and allow for flexibility between the vertebrae of the spine. A herniated disc, also called a ruptured or slipped disc, is a common condition that may occur as a result of gradual wear and tear on the disc or from an injury to the spine that cracks or tears the disc and causes it to bulge or break open. This can produce pain, numbness and weakness in the back or legs as the disc presses on the nearby nerve roots. It is important to determine which disc or discs are damaged in order to ensure that the patient will receive the appropriate form of treatment.
A discography test is performed by injecting a special dye into the patient's spinal discs and using imaging technology to view the area in greater detail. Due to its invasive nature, a discography is only considered for patients with persistent back pain that remains unresponsive to treatment. A discography may also be performed on candidates for spinal fusion surgery to identify the damaged discs that will need to be removed during surgery.