Spinal Cord Stimulators/Spinal Infusion Pumps

Implantable Therapy – Neuromodulation

    • Neuromodulation is the electrical or chemical modulation of the Central Nervous System to reduce pain or improve neurologic function
  • Types
      • Spinal cord stimulation
      • Intrathecal infusion delivery systems – Spinal Infusion Pump

Intrathecal Infusion Systems – Targeted Drug Delivery – Spinal Infusion Pump

  • An implanted system to treat chronic pain; the system delivers precise doses of prescribed pain medication directly into the cerebrospinal fluid (CSF) to disrupt and control pain signals
  • Pain Pumps treat intractable nervous system pain and mixed source pain patterns – including cancer pain
  • Baclofen Pumps treat spasticity, myoclonus, and other muscle symptoms from Multiple Sclerosis, Post-Stroke Syndrome, and other Neuromusclular Diseases.

Spinal Cord Stimulation – Indications for Use

  • Failure of conservative therapy, including pain clinic treatments
  • Unsuccessful surgery or not a candidate for surgical options
  • Medications are either unsuccessful, utilize excessive dosing, or are associated with side effects
  • Post-Laminectomy cervical / lumbar axial / radicular spinal syndromes
  • Peripheral neuropathic conditions
  • Phantom Limb / Post-amputation syndrome
  • Post-herpetic neuralgia

Indications for Implanatble Therapies

SCS / Spinal Infusion Pump

  • Failure of conservative therapy
  • Surgical failure, poor candidate for surgery

SCS

  • Neuropathic and mixed pain conditions
  • Regionalized pain patterns
  • High success; post-laminectomy, peripheral neuropathy

Pumps

  • Multiple region pain
  • Nociceptive and mixed pain conditions
  • SCS failure
  • Spasticity

Potential Benefits of Implantable Therapies: SCS / Spinal Infusion Pump

  • Pain control
  • Functional restoration / improvement
  • Quality of life improvement
  • Medication requirement reduction

Spinal / Intrathecal drug delivery systems – 2 stage process; Trial and Implant

Trial – SCS

  • No laminectomy, just needle placement of leads, stimulators
  • For SCS – no incisions, outpatient procedure, performed in office with home trial, 10 – 14 days
  • Percutaneous lead placement with external generator
  • Success defined as; minimum 50% pain control, improved functionality, improved quality of life, and reduced medication use
  • Insurance requires Psychology / Cognitive workup pre and post trial

Trial – Pump

  • Hospital based, can be outpatient or overnight stay is optional
  • 2 components are spinal catheter for the infusion of the medication, and the pump which holds the medication and infuses the medication through the catheter
  • There is no laminectomy, the trial will involve the surgical placement of the catheter, and use an external pump
  • The surgically implanted spinal catheter interfaced with external pump infusing the pain medication into the spine and nervous system, if the trial is successful, the catheter stays in place, the external pump is removed, and the permanent pump placed under the skin
  • Routine epidural blood patch done along with the implanted catheter technique to reduce the incidence of a spinal headache

Spinal Cord Stimulation / Spinal Infusion Pump – Permanent

Implant – if trial successful. The procedure will be hospital based, either can be outpatient with an overnight hospital stay as an option

  • Success defined for both as pain control, functionality improvement, medication reduction, improved quality of life
  • SCS – no spinal surgery, just the placement of both the stimulator leads and the pulse generator that drives the system, under the skin.
  • Pump – No spinal surgery just the placement of the spinal catheter ( at the trial ) and the pump reservoir that holds the medication and pumps the medication through the catheter.