Spinal Chord Stimulators
Spinal Cord Stimulators and Spinal Pumps Spinal cord stimulators and spinal pumps are implantable systems which are used to treat a variety of conditions including pain and spasticity as well as to deliver therapeutic agents. Use of these modalities is growing through advances in technology and effectiveness and greater education of patients and physicians as to their availability, options, and indications. At Columbia, we have a Pain Center consisting of specialists from Neurosurgery, Neurology, and Anesthesiology dedicated to patient care and research.
Spinal Cord Stimulators
Spinal cord stimulators are surgically implanted devices which are designed to provide pain relief from chronic intractable pain. Prior to placing an implantable spinal cord stimulator, typically the patients receives a trial of a temporary stimulator to assess the efficacy of stimulation in providing pain relief for that patient.
The surgical procedure involves placing a compact generator in the lower anterior abdomen wall and connecting a wire to a strip of electrodes placed adjacent to the back part of the spinal cord. Through low-voltage electrical stimulation of the electrodes, the normal pain signals which travel in the posterior parts of the spinal cord are altered to provide partial or complete pain relief from conditions such as cancer pain, post-spinal cord injury pain, and pain from reflex sympathetic dystrophy (RSD).
Modern spinal cord stimulators are programmable so that once implanted, the signal can be adjusted for optimal pain relief. At Columbia, we are investigating techniques to improve the efficacy of spinal cord stimulators.
The initial attempt to infuse an anesthetic agent into the spinal epidural space (the area surrounding the spinal cord and nerve roots) was back in 1976. Since then, a number of technological, surgical, and pharmaceutical advances have revolutionized the treatment of chronic and intractable pain, spasticity, and a variety of other conditions which can benefit from long-term direct infusion of a compound into the epidural space.
Typically, the surgery involves placing a reservoir under the skin of the lower anterior abdomen. At the same time, from the back a catheter is placed into the spinal epiidural space and then tunneled under the skin to connect to the reservoir. Thus the contents of the reservoir, typically morphine (to treat pain) or baclofen (for spasticity), can be delivered to the epidual space in a controlled fashion via the pump in the reservoir. The reservoirs can be refilled as necessary.
To determine if a patient would be a good candidate for a spinal pump, a trial injection via a lumbar puncture is performed. Those patients who receive the desired result (eg pain or spasticity relief) are considered for placement of a pump. In addition to pain and spasticity, spinal epidural pumps can be used as a number of other application such as chemotherapy and hormonal therapy.