SPINAL CORD STIMULATOR

 

A spinal cord stimulator (SCS) is a medical device used to exert pulsed electrical signals to the spinal cord to control chronic pain. The device, typically implanted under the skin, sends a mild electric current to the spinal cord. Thin wires carry current from a pulse generator to the nerve fibers of the spinal cord. When turned on, the SCS stimulates the nerves in the area where your pain is felt. Pain is replaced by a mild tingling sensation. The device can be turned on and off, and adjusted using an external remote.

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This therapy is often considered when other methods have failed to relieve pain. It's particularly effective for neuropathic pain, which is pain caused by damage to the nerves. Conditions that may benefit from SCS include chronic leg or arm pain, failed back surgery syndrome, and complex regional pain syndrome.

 

The implantation of a spinal cord stimulator is typically done in two stages. First, a trial stimulator is inserted to determine if it reduces pain. If successful, a permanent stimulator is then implanted. The procedure for implanting a spinal cord stimulator involves inserting the leads through a needle placed in the back near the spinal cord. The leads are connected to a pulse generator, which is placed under the skin in the lower back or buttocks.

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An SCS provides electrical stimulation to the dorsal column, lateral funiculus, and dorsal roots.

                                                                                                 

                                                     Anesthetic Implications for Spinal Cord Stimulator

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Anesthesia type: TIVA

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Airway: ETT, spontaneous ventilation

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Preoperative:

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• Fluoroscopy/X-ray will be used

• Make sure patient is comfortably positioned prior to sedation

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Intraoperative:

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• Position: "Superman" > prone with arms extended and flexed

• Duration: 1-2 hours

• An SCS consists of leads containing electrodes that are placed in the dorsal epidural space

• The lead is anchored with sutures to the supraspinous ligament and tunneled subcutaneously

• When the stimulator cords are in place, the patient will be shortly woken up to assess the efficacy of the stimulator

• During tunnelling of SCS leads and creation of a subcutaneous pocket for pulse generator implantation, general anesthesia (TIVA) is often administereed

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Postoperative:

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• Procedural pain

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Complications:

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• ​Cerebrospinal fluid leak

• Hematoma

• Infection

• Technical complications of device

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Sources:

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Bull C, Baranidharan G. Spinal cord stimulators and implications for anaesthesia. BJA Educ. 2020 Jun;20(6):182-183. doi: 10.1016/j.bjae.2020.02.005. Epub 2020 Mar 24. PMID: 33456948; PMCID: PMC7807848.

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Elisha, S. (2010). Case Studies in Nurse Anesthesia.

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Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice. 

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Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.). 

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Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.

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