Spinal Cord Stimulation for Failed Back Syndrome

by Christina Lasich, MD Health Professional

Failed Back Syndrome can be devastating after spinal surgery offers such hope to those with none.
Unfortunately, some end up with a "failed" surgery. Failure to improve pain. Failure to improve quality of life. Failure to help.
Where does a person turn when the pain mercilessly continues? Some turn to a futuristic treatment called spinal cord stimulation which is gaining more and more popularity.
This operative procedure places electrical leads near the spinal cord. These leads are then connected to a "generator" which is implanted in the abdomen or buttocks. The electrical current generated near the spinal cord theoretically blocks pain signals. How successful is this pain treatment for failed back syndrome? What are the risks? Is it an option for you? Let's take a look.

When a spinal surgery failed in the past, a person's only option was to take pain medication or to try a reoperation. Another operation is always risky business. In 2005, a study compared the results of reoperation versus the newer treatment for post-surgical pain-spinal cord stimulation. The researchers reported a much better success rate with spinal cord stimulation when looking at patient satisfaction and analgesic medication use. In 2007, another group of researchers again studied spinal cord stimulation and compared it with conventional medical management. 48% of those treated with spinal cord stimulation had a 50% reduction in pain while only 9% of those treated with medications had a 50% reduction of pain. These results certainly sound promising and that is why spinal cord stimulation is gaining popularity. So why doesn't everyone rush into getting a spinal cord stimulator?

People do not jump into this procedure because of the risks. Implants of any type always have a bit of risk involved. Infections are a big problem anytime a foreign object is placed in the body because it gives a place for bugs to hide. With spinal cord stimulators, the risk of infection can be upwards of a 10% rate. Another problem is that the implant itself can cause pain. But far and away the largest complication of spinal cord stimulation is electrical lead migration. The wires move out of place. The wires can also break or the generator can malfunction. All this adds up to a revision rate of nearly 35%. Just when someone thought that the troubles were behind him/her, more failure happens.

Those who are willing to accept the risk of spinal cord stimulators will want to know who the ideal candidates for this innovative pain treatment are. Traditionally, leg pain is the predominant pain complaint that can be successful treated by the stimulator. The electrical "coverage" is best in the legs. Just like with cellular phones, signal coverage is important. And as this technology improves, so does the coverage. In order to be considered an implant candidate, one should have a least tried conservative care like physical therapy, injections and medications. Finally, spinal cord stimulators are not implanted without a trial. The trial involves a temporary stimulator. 50% pain relief during the trial means that a permanent implant could be worth the risk. There is that word again-risk. Is spinal cord stimulation worth the risk if you are the right candidate? That question really becomes a personal, individual choice.

Anyone with failed back syndrome is grateful to have choices. Spinal cord stimulation is a valuable and worthy option that deserves consideration. Of course with any option, there are success stories and then there are horror stories. Could spinal cord stimulation be the next chapter in your story? Talk with your doctor.

Christina Lasich, MD
Meet Our Writer
Christina Lasich, MD

Christina Lasich, M.D., wrote about chronic pain and osteoarthritis for HealthCentral. She is physiatrist in Grass Valley, California. She specializes in pain management and spine rehabilitation.