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Spinal Cord Stimulation is a surgical procedure which involves a 7 day process with two stages:
Stage 1-Trial Stimulation
Trial stimulation is very important to determine if the procedure will be successful. The first stage is completed as an inpatient.
In the operating room, you will be placed on your stomach on the operating table; the team will work to make you comfortable. The area of your back will be cleaned and possibly shaved to prepare for insertion of the leads. You will be given sedation and pain medication to ensure your comfort during the surgery. You will not have a general anesthetic. This will be a very quick procedure.
Placement of the surgical leads is performed. A small incision is made in the midline of your back. The bony arch of your back is exposed and a piece of lamina is removed to allow room for insertion of the leads with the attached wires. The leads are placed in the epidural space and secured with sutures. The inserted wires are then secured outside the body (e.g. externalized) and attached to the temporary pulse generator device which is secured in your posterior pelvic area for your SCS trial to begin. An x-ray may be completed in the operating room or after surgery to ensure proper positioning of the leads in the epidural space.
The nurse practitioner will connect the temporary pulse generator to an external battery pack in order to test the leads and introduce to the feeling of paresthesia (tingling sensation in the area of pain).
The trial period typically occurs over a 7 day hospital stay whereby different programs will be tried and adjusted to identify which program may be right for you.
You will be asked to keep a written log of what you liked, disliked and your pain score while the stimulator is on to help the nurse practitioner make appropriate adjustments throughout your trial.
After Stage 1 Surgery
When the surgery is finished, you go to the PACU for 1 hour to recover. Nurses check your blood pressure, pulse, temperature and breathing often, as you wake up. If you have pain or nausea, they will give you medicines that will help. You may have an oxygen mask over your mouth and/or nose.
When you are ready, you are taken to your room on the Neurosurgery Unit (5A or 5B)
Stage 2: Internalization of wires and insertion of internal pulse generator and battery pack (IPG).If you and the neurosurgeon have decided after your trial that SCS is not right for you, the wires will be removed and the skin tissue repaired.
If you and the neurosurgeon find that the SCS proves helpful reducing your pain substantially (e.g. lowering your pain by 50% or more), then the second stage will be completed
The second stage occurs while you are back in the operating room and under a general anesthetic (e.g. asleep). Extension wires will be passed under the skin from the spine around the torso to the abdomen or buttock where the pulse generator will be inserted; this choice is up to you.
An incision will be made either lower abdomen or buttock where the surgeon will create a pocket for the generator between the skin and muscle layers. The extension wires are attached to the pulse generator (battery). The battery is correctly positioned and sutured to the area overlying the muscle. The incisions are closed with staples or sutures
Your programs that were trialled in the hospital will be programmed into your device prior to your discharge home.
After Stage 2 Surgery
When the surgery is finished, you go to the PACU for 1 to 3 hours to recover. Nurses check your blood pressure, pulse, temperature and breathing often, as you wake up. If you have pain or nausea, they will give you medicines that will help. You may have an oxygen mask over your mouth and/or nose.
When you are ready, you are taken to your room on the Neurosurgery Unit (5A or 5B).
Spinal cord stimulation surgery usually takes 90 minutes to 2 hours.
We do everything that we can to stay on time. Unfortunately, your surgery may be delayed by unforeseen or emergency circumstances.
In the Neurosurgery Unit, your health care team continues to check your recovery. You may have back pain, feel pain over your incisions and/or have nausea. This will slowly get better. The nurses can give you medicines for your pain and nausea if you need them.
In the afternoon or evening you can start to drink and eat. Later in the day or the next day, the nurses help you get out of bed and walk. You may feel dizzy, so it is important that someone is with you the first few times you get out of bed.
You can expect to go home 1 or 2 days after the second stage of surgery. Please plan for someone to take you home before 11:00 am on the day you are discharged home.
Before you leave the hospital, a member of your health care team will review:
Follow these rules for safety when you have a SCS system: