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Spinal cord stimulator act in by several ways.
This therapy aims at pain relief in patients who are refractory to all other treatment modalities. They are very tough group to get good results.
There are many advantages of using this therapy like:
Selection criteria for spinal cord stimolation are -
If we weigh between sufferings, total cost of other form of treatment SCS is cheaper if patient can afford.
1. In most patients SCS can be kept in “OFF” mode for sometimes without return of pain. Otherwise patients can lead near normal life style.
2. There are some situation when it is kept in “OFF” mode by a remote or magnet by the patients themselves.
3. Normal household equipment, such as cell or portable phones, computers, TVs, microwaves, and other appliances are safe to use with the stimulator.
The procedure involves percutaneous insertion of lead, typically a ‘longitudinal’ lead with a linear array of electrodes through an epidural needle into the epidural space and oriented parallel to spinal column. First step is the introduction of a trial electrode for temporary purpose. The lead is connected to an external battery source that transmits radiofrequency signals to the lead. The external transmitters help in adjusting the amplitude, pulse width and rate of stimulation. The low voltage electrical stimulation is applied to the spinal cord to create a current field that activates neurons in the dorsal column. This stimulation is done by the external power supply connected to lead by either a conducting wire or extension. The stimulation produces paraesthesia that interferes with or blocks pain signals to brain. The vertebral level at which it is placed depends upon the location of pain. If patient gets 50% or more pain relief after trial stimulation, then patient is considered for permanent implant. Replacing the temporary lead with permanent lead usually does this. Implanted pulse generator provides the power supply.
1. Driving cars or using heavy equipment.
2. Passing through metal detectors.
3. Passing through anti-theft devices.
4. When flying, during take off and landing.
1. It depends on type of IPG.
2. It depends on type of stimulation parameter.
3. With conventional type it is effective for 5-8 years. IPG should be replaced after that.
It is like temporary pacemaker. The stimulating electrodes / leads are implanted and stimulated with external power source. Then the patient is asked to assess pain relief over next few days. If pain relief is more than 50% then permanent implantation is done.
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