Sometimes a patient with back pain has tried everything, pain killers, physical therapy, injections, even surgery, and still has pain. This is where specialists like Dr. Christopher Winfree from our Pain Center come in. He can surgically implant a spinal nerve root stimulator (SNRS) to block pain signals to the brain. Dr. Winfree spoke to neurosurgeons at the World Congress of Neurological Surgeons Annual Meeting 2009 about how to do this. He gave an overview of several placement methods and their best use.
An SNRS is similar to a pacemaker. It has a small power unit that attaches to electrodes that deliver electrical impulses. Patients can control their intensity with a remote. When delivered to a nerve the electrical stimulation can override pain signals. Think of nerves as telephone wires to and from our brain. If pain is a bill collector on the line, then an SNRS offers a way to turn up the static so we canʼt hear him. These devices can be placed anywhere along a nerveʼs pathway: at the spinal cord, as it exits the spine, as it travels down the arm or leg, or just under the skin.
Placement on the spinal cord is often a surgeonʼs ﬁrst choice to immediately relieve pain in the arms or legs. This technique has a long track record but it has limitations. Pain speciﬁc to the low back, hand, foot, groin and buttock can be harder to target with this approach. Also, over time, pain can stop responding to the spinal cord stimulation. For these reasons, surgeons may choose another placement point, initially or supplementally.
Nerves become easier to access speciﬁcally, once they come off the spinal cord. Pain that lies within the pathway of a certain nerve can be relieved by placing an SNRS electrode anywhere along that nerve between the spine and the painful area. A couple of techniques have been developed to target nerves as they exit the spinal cord (see our blog, A New Way to Give an Old Vet Relief to learn more). Electrodes can also be placed further along the nerve closer to the area of pain. For example, some nerves in the foot can actually be targeted in the back of the knee (see our Peripheral Nerve Center featured article Surgeons Use Ultrasound, Not to Find a Baby, but a Nerve to learn more).
Targeting nerves in this way can provide signiﬁcant relief but only when pain falls inside a speciﬁc nerveʼs pathway. When it doesnʼt, SNRS electrodes can be placed under the skin, right where it hurts.
Each method has its best use and any one may be just what a patient needs. Patients who end up at the Pain Center sometimes have much more complicated pain patterns and need a combination of methods. In any case, an SNRS can be a powerful tool that provides long suffering patients with a way to turn up the static when pain calls; in fact, they may not even hear the phone ring.
You have added pages to your clipboard. Please log in or create an account to share them or use later.
You are now being taken to Columbia Neurosurgery's site dedicated to the spine.
Use this button to save pages to your clipboard for future use.OK. Got it.