Surgical Procedure
Percutaneous Procedure
How to Prepare
Meeting with the pain physician/neurosurgeon
After all assessments are complete and the team members feel you are a good candidate for SCS, you will meet with the appropriate physician to review all investigations and assessments and together decide if you wish to go ahead. They will explain the procedure/surgery, its risks and benefits, and answer your questions. Bring a family member or support person to this appointment.
Afterward, the pain physician/neurosurgeon's office will schedule a pre-admission assessment for you.
Pre-admission assessment
You have your pre-admission clinic appointment a few days or weeks before your surgery. This visit takes about 3 to 4 hours in order to obtain blood work,
ECG,
CXR, have a consultation with an anesthetist and the pre-admit nurse will review instructions on how to prepare for the surgery.
Please bring the following with you:
- Your Ontario Health Card
- All medications you take and their containers.
If there are any changes in the booking of your surgery, you will be called by the pre-admit department.
If you cannot go to your surgery, call the doctor's office as soon as you know. If you are unable to reach the doctor, then leave a message at the surgeon's office.
The day before your surgery
Do not eat any food or drink after midnight the night before your surgery. Your stomach must be empty.
Take a shower the night before or the morning of your surgery.
Please bring with you a list of your current medications. This includes prescription medications, over-the-counter medications, vitamin or mineral supplements and herbal remedies. The nurse will go over these medications and instruct you on them for the surgery.
Checking In
You should arrive at the POCU at 6:00 am on the day of your procedure/surgery, if you are the first case, otherwise 2 hours before your scheduled procedure time. When you arrive at the POCU, check in at the reception desk. Please have the following ready:
- Health card (OHIP card). If you do not have an OHIP card, please bring another form of government-issued photo ID (such as a driver's license, passport, or other provincial health card). Please arrive 15 minutes before your appointment.
- Your name, address and birth date
When you check-in, the receptionist will give you a name band to wear.
Before the Spinal Cord Stimulation
After check-in, the nurse will admit you and help you get ready for surgery. They check your blood pressure, pulse, temperature and breathing. They will also put an intravenous (IV) in your arm and help you change into a hospital gown. You will then be taken into the operating room.
Surgical Procedure
During and After the Surgical Procedure
Spinal Cord Stimulation is a surgical procedure that 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 the 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 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 in the Neurosurgery Unit (5A or 5B)
Stage 2: Internalization of wires and insertion of the 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 in 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 in either the 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 trialed 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 in the Neurosurgery Unit (5A or 5B).
How Long Will Your Surgery Take?
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.
Neurosurgery Unit
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.
Discharge Home
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:
- Your medications
- How to care for yourself, what to watch for and how to get help if you need it. The controller for your spinal cord stimulator and a card that has your device information will be sent home with you. Your SCS device will be turned on before you leave the hospital. If your settings are not the same at home after a couple of weeks, this is ok; they can be adjusted in the clinic.
- Any follow-up appointments. You will see your neurosurgeon 6 to 8 weeks after your surgery. He/she will check the surgical incisions and adjust your SCS device settings if they are needed. Make an appointment with your family doctor to have your staples removed 10 to 14 days after surgery.
Follow these rules for safety when you have an SCS system:
-
Do not have an MRI. Currently, the SCS is not MRI-safe therefore, if you require an MRI in the future please contact the neurosurgeon's office, as the device would have to be removed.
Percutaneous Procedure
During and After the Percutaneous Procedure
Stage 1: The lead is placed around the epidural space (the area under the spinal bones but outside your spinal cord) and the wires are externalized (hanging outside your body). These wires will be used in your trial session. There are two types of trials – percutaneous and tunneled. Most patients who are in these trials are discharged to home the same day as the procedure but some patients may need to stay in the hospital during the trial. Assessment during the trial involves the use of validated questionnaires, activity trackers, and imaging modalities to establish improvement in pain, activities, sleep, mood and reduction in the use of painkillers. A percutaneous trial ends with the removal of the lead whereas a tunneled trial may end with the removal of the lead or its internalization as part of a full implant (see stage 2 below).
Stage 2: This stage involves a full implant of spinal cord stimulation and is performed following a successful trial. This stage can occur from within a week (usually following the start of a tunneled trial) to one to months (following the end of a percutaneous trial) after the trial. The SCS device will be turned on after the surgery and adjusted to the programs obtained during your trial phase.
How Long Will Your Surgery Take?
Spinal cord stimulation surgery usually takes 90 minutes to 2 hours.
We do everything that we can to stay on time. Unfortunately, your procedure may be delayed by unforeseen or emergency circumstances.
Discharge Home
You can expect to go home the same day as your procedure.
Before you leave the hospital, a member of your health care team will review:
- Your medications
- How to care for yourself, what to watch for and how to get help if you need it. The controller for your spinal cord stimulator and a card that has your device information will be sent home with you. Your SCS device will be turned on before you leave the hospital. If your settings are not the same at home after a couple of weeks, this is ok; they can be adjusted in the clinic.
- Any follow-up appointments. You will see your pain physician 6 to 8 weeks after your surgery. He/she will check the surgical incisions and adjust your SCS device settings if they are needed. Make an appointment with your family doctor to have your staples removed 10 to 14 days after surgery.
Follow these rules for safety when you have an SCS system:
-
Do not have an MRI. Currently, the SCS is not MRI-safe therefore, if you require an MRI in the future please contact the neurosurgeon's office, as the device would have to be removed.
