When Your Spinal Cord Stimulator Needs to Come Out

Spinal cord stimulation is cutting-edge pain management, but does it always work? No, and sometimes your device needs to be removed. Here’s when—and why.

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The world of pain management and resolution has changed drastically over the last few decades, giving patients living with chronic pain myriad options to improve their pain and lives. Among the injections, therapies, and medications, spinal cord stimulation stands out as one of the most innovative procedures of its time if your pain just won’t quit.

Spinal cord stimulator removalSometimes your spinal cord stimulator needs to be removed. Here's when--and why.

However, no procedure is perfect. Sometimes spinal cord stimulator (SCS) devices lose their efficacy and need to be removed.  Will yours?

First, What Is Spinal Cord Stimulation?

Spinal cord stimulation uses the power of a device known as a pulse generator. The device goes under your skin, with the stimulator near your buttocks and an electrical lead near your spinal cord that disrupts pain signals before they have a chance to reach your brain and replaces them with different and more pleasing sensations.

In addition to chronic back pain, SCS can treat symptoms stemming from:

How Is an SCS Device Implanted?

To determine if SCS is viable for you, you’ll undergo a trial before permanent implantation. During the trial, temporary electrodes connected to wires are placed directly on the spinal cord. These wires connect to an external battery on a belt.

After the procedure, you are asked to keep detailed records of your experience, including the various stimulation levels during certain activities and your level of pain relief.  It’s important to remember that for some patients any stimulation or sensation is novel and distracts from the baseline pain. Sometimes anything feels better than the chronic pain they have felt. 

If your symptoms improve during the trial period, permanent implantation of the device is often considered as the next step. This is when your surgeon put wires along the spinal cord and a pocket is created between skin and muscle to insert the device. Once the wires and the device are connected, the incision is closed, and the implantation is complete.

Why Would the SCS Device Need to Be Removed?

There could be a number of reasons your SCS device may become ineffective and ultimately removed. One 2020 study in the journal Neuromodulation found that up to 30 percent of patients who undergo SCS will have their devices removed within five years.

You may hear your doctor talking about spinal cord stimulator explantation surgery; that just means removing your device. Let’s take a look at some of the reasons why SCS may not be as effective in the long term.

Ineffectiveness

Unfortunately, despite the trial period, some patients don’t respond to spinal cord stimulation long-term the way they expected. Some studies suggest that inadequate pain control is the biggest determining factor for having the device removed.

Discomfort

Even in situations where you are benefiting from the effects of SCS, it may not outweigh the simple fact that there is a device under beneath the skin. The sheer discomfort caused by the hardware can have you opting for removal.

Incompatibility with Other Devices

One of the more inconvenient reasons for SCS explantation is that you might need to have magnetic resonance imaging (MRI) performed at some point in your life. Some SCS devices contains metallic components that prohibit you from getting a MRI scan.  Some newer devices are compatible with MRI images, but only certain scans in certain conditions.

New Nerve-Related Symptoms

Though stimulation may effectively treat the pain it was designed to relieve, sometimes explantation becomes necessary because stimulator presence creates a new set of problems for you. One study showed that almost 40 percent of patients reviewed underwent explant because they were experiencing paresthesia—basically pins and needles--and/or dysesthesia (a burning, itching, or aching sensation that usually occurs in the legs or feet) after having their device implanted.

Other Factors

There are some other indications where explanation may become necessary, including:

  • Infection post-surgery that does not improve with medication
  • The agitation of certain psychiatric conditions
  • Hardware complications, such as lead migration, failure, or fracture
  • Physical discomfort from the implanted stimulator and/or leads.

Most patients who undergo SCS implantation are satisfied with the results. However, it is a last resort for some, and sometimes the long-term benefits are not sustained . It’s not a simple procedure and needs to be considered carefully. Not every patient benefits over time and sometimes it the technology doesn’t produce the results you need. You should discuss all options at length with your healthcare providers to develop options and have alternatives available. 

 

Updated on: 09/02/20
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Spinal Cord Stimulation: Risks and Benefits
Jason M. Highsmith, MD
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Spinal Cord Stimulation: Risks and Benefits

While there is no guarantee that spinal cord stimulation will alleviate all of your discomfort, most patients report a 50% - 70% decrease in pain.
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