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Spinal or Dorsal Column Stimulation

A Dorsal Column or Spinal Cord Stimulator is a device used to control pain caused by various forms of nerve damage referred to as neuropathic pain. It is an implantable device composed of two main components including a special catheter and a battery power electric pulse generator. It is commonly called an implantable TENS unit.

There are several theories on how the dorsal column stimulator works but the simplest explanation involves providing an actual electrical impulse directly to the lower part of the spinal cord to “cover-up”, “drown out”, or “replace” painful nerve impulses traveling up the spinal nerves and spinal cord to the brain. The idea is to trick the brain to perceive the impulses from the stimulator and not the damaged nerve(s) thereby eliminating the perception of pain.

The device is typically inserted in two stages. The first is the trial phase and is generally performed under local anesthesia. This gives the patient the opportunity to “try out” the device for a week or more to determine if it works to alleviate their pain. If so, then a permanent device is implanted similar to a pacemaker under the skin using general anesthesia. The patient is given a small external controller device about the size of a cell phone that they use to program and operate all aspects of the device’s function. The battery usually lasts for 3-4 years depending on use.

Fifty to seventy percent of patients report good to excellent relief of their pain depending on their underlying condition. Conditions such as neuropathies, post traumatic neuritis, regional pain syndrome (RSD), and herpetic neuralgia are a few conditions that respond best to this treatment. Nociceptive pain, or pain from arthritis, inflammation, acute trauma, pulled muscle, or pinched nerves have the least response. A careful analysis of the patient’s pain type is essential prior to trying the spinal cord stimulator. A test called an EMG/nerve conduction study is very helpful and should be performed.