Dorsal Column Stimulation

What Is Dorsal Column Stimulation?

Dorsal column stimulation is a minimally invasive treatment for intractable pain in the back and extremities. As a pain management technique, it interferes with the transmission of pain signals from the nerves to the brain, and can significantly reduce pain and improve the ability to participate in daily activities. Dorsal column stimulation is a reversible neuromodulation technique.

What Conditions Does Dorsal Column Stimulation Treat?

This FDA-approved procedure is used to treat a variety of chronic back pain conditions:

  • Chronic Pain — ongoing pain that is not alleviated with other treatments
  • Phantom Limb Pain — pain messages continue to be received by the brain even though the limb (or other body part such as eye, breast or teeth) is no longer there
  • Postherpetic Neuralgia — continued nerve pain after a shingles episode
  • Sciatica — if surgery is not an option for the treatment of the pain, numbness or tingling sensations down the leg from an impinged nerve, dorsal column stimulation may be recommended
  • Peripheral Neuropathy — damage or diseases that cause pain along the nerve pathway
  • Failed Back Syndrome — chronic pain after back surgery
  • Spinal Stenosis — a narrowing of the spinal canal
  • Complex Regional Pain Syndrome — prolonged pain usually in a limb with changes to the skin and swelling
  • Spinal Cord Injury — an incomplete spinal cord injury may cause chronic pain

Dorsal column stimulation (DCS) is only recommended after more conservative treatments such as physical therapy, medication and injections have failed to alleviate the pain. DCS does not cure the underlying condition causing the pain, but the neurostimulation provides a low frequency that excites the neurons and impairs their ability to send pain messages to the brain.

Dorsal Column Stimulation Treatments at NSPC

If surgical treatments have not been successful or are not an available alternative to treat the underlying cause of your condition, dorsal column stimulation may be your best option for your chronic back or limb pain.

The procedure is a two-step process:

Trial Stimulation

Before the battery-operated generator is implanted under the skin of the abdomen or buttocks, the neurostimulator is tested to verify that it does significantly reduce pain and to determine which stimulation settings work best.

  • A local anesthetic applied to the skin on the lower back. Using fluoroscopic imaging, the surgeon inserts an epidural needle close to the spinal cords.
  • Electrodes are inserted and wires are attached to an external stimulator.
  • The patient can then use the generator to apply low-level stimulation to the area.

The patient tracks the effectiveness of the different settings. If after about a week, the trial stimulation is effective in alleviating pain symptoms, a more permanent implantation of the lead wires and generator occurs.

Permanent Implantation of Dorsal Column Stimulator

Implantation is a more complicated procedure than the trial stimulation.

  • The patient usually only requires a local numbing agent and an intravenous sedative. This allows the patient to remain awake and answer questions regarding the effective placement of the device.
  • Sometimes the neurosurgeon removes a small portion of the bony arch of the vertebra (called the lamina) to make room for the thin, small wires that are implanted under the skin to the generator.
  • A small incision is made in either the abdomen or upper buttocks for the pulse generator. The battery-operated generator is implanted between the skin and the muscles.

Often the patient is discharged the same day or the following day. The electrical stimulation can be controlled by a handheld device that turns the generator on or off, controls the strength of the stimulation and chooses which programs to run.

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