DAVID W. LEE, M.D.
INTERVENTIONAL PAIN & SPINE
FULLERTON ORTHOPEDICS
UNIVERSITY OF CALIFORNIA IRVINE AFFILIATE
SPINAL CORD STIMULATION (SCS) & DORSAL ROOT GANGLION STIMULATION (DRG-S)
Spinal Cord Stimulator (SCS) involves placing thin wires outside the sac that carries the spinal cord. The wires carry electricity from an implanted pulse generator. The system is akin to a pacemaker for the heart. When turned on the SCS stimulates the nerves thereby blocking signals from otherwise painful areas. Electrical pulses modify and mask the pain signal from reaching your brain, thus improving the painful experience.
Patients most likely to benefit from SCS are those that have chronic back and/or leg (sciatica) pain and have failed conservative management, or have failed advanced treatments including epidural injections or surgery. Diagnosis that often benefit from SCS include failed back surgery syndrome, complex regional pain syndrome (CRPS), and painful neuropathy. The one unique aspect of SCS is that there is a trial. In this way, the patient is able to “test drive” the system to see how well it will work for their pain. The trial involves wires placed underneath the skin. There is an external battery, which sits in a pocket on the outside of your skin.
The trial typically lasts a few days. Once the trial is over, the wires are removed in the office and the patient discusses the results with their pain specialist. If the pain relief is at least 50%, then patients are candidates for the implant procedure. The implant is done similar to the trial procedure, however, the wires and battery are placed underneath the skin. The patient has a controller or may download an app on their smartphone to control the type or strength of stimulation delivered to the nerves.
Dorsal root ganglion stimulation (DRG-S) is a more targeted form of spinal cord stimulation.
Instead of placing the wire in the main column where the spinal cord is located, DRG-S places a smaller wire next to a specific branch. In this way, DRG-S is more specific and accurate in coverage. This has led to improved coverage for focal pain symptoms such pain in the knee or ankle, chest wall, and abdomen or pelvis. Both SCS and DRG-S therapies use electricity, without the need for medications (opioids), to treat pain symptoms.