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Spinal Cord Stimulator

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2

Comments

  • Fusions are intended to do one thing and one thing only - stabilize the spine. A fusion is not a pain management tool. In some cases, physically stabilizing the spine with a fusion is enough to reduce or relieve pain. If the pain remains, then you have to move on to procedures that are pain management tools.

    Declaring a fusion was a failure because it didn't resolve your pain would be the equivalent of declaring the SCS a failure because it didn't decompress nerve roots. It's not the respective purpose of each procedure, so you can't use it as criteria to evaluate the outcome.

    There is one other very important factor that's getting glossed over with the idea of getting the SCS as a band-aid and planning to fix real problems later.

    Once that SCS is implanted EVERYTHING changes.

    Do you know what really happens with doctors if you require major spinal surgery after the SCS has been placed? I do, because I'm living through it.

    The first thing you notice is that the surgeon becomes very wary. They spend more time than usual staring at the various radiology films, with their hand on their chin or their pen tapping on the table. They start to say something, then they pause, then the pause becomes a full stop. Complete sentences become the exception, rather than the rule.

    Instead of appointments ending with a plan of action, they end with the plan to consult the doctor that's managing the SCS. The surgeon's focus changes from correcting the original problem to finding out how the various surgical options will impact the SCS AND how the SCS will impact those surgical options. Instead of planning for the best outcome, the surgeon begins planning for the outcome with the fewest complications. It's a subtle, but very important difference.

    When you return to your pain management doctor, you notice that they, too, have become wary because they're being put on the spot for answers about the SCS that are largely unknowable. The SCS rep becomes involved, to try to provide some of the answers, from very basic to very complex issues. Certain electrocautery tools are contraindicated with the SCS, so which can and which can't be used during this surgery? How will that effect blood loss during surgery? What are the chances of extensive hammering against the spine causing paddle migration? Lead fractures? Dural tears? The list goes on, and on, and on, with no clear cut answers.

    The pause becomes an integral part of your medical team and begins attending all of your appointments. When nobody knows the answers to these surgical unknowns, the pause jumps in and seems to explain the issues. Instead of the normal confidence of the surgeon and pain management doctor, their demeanor changes and sentences constantly start with words that inspire anything but confidence. Nobody wants to see their doctors visibly uncomfortable with a situation, and hear every other sentence begin with "would it work to..." or "maybe we could..." or the real biggie - "what if we try ______ .. and if that's not looking good, we'll back up and try... ______.. and if that doesn't work.. well... ~~trailing into silence~~"

    You might think that going forward with the SCS and telling your doctors ahead of time that you want to get fused later will change this scenario, but it won't. The presence of the SCS trumps all the plans you think you've made.

    As soon as that SCS goes in, you become a high risk surgical candidate and short of emergency surgery for life-threatening issues, nobody really wants to take the risk. None of the doctors involved really want to take responsibility for the laundry list of things that can go wrong, just because the SCS is there. Even if there's a clear need for surgical intervention, you will find yourself facing an uphill battle to get it done. Weeks turn to months of increasing pain and decreasing function, while you wait for the doctor(s) and SCS rep(s) to sort things out.

    This is just one of the many parts of life that changes the moment that SCS is placed. As a person that has been through the entire process and experienced life after the SCS implant, I completely understand the inability of patients to fully comprehend all the changes to come. Others who have been through the process can chime in, but I believe that the full impact of post SCS life doesn't set in completely until about 1.5-2 years after the implant.

    From where I am right now, I can't even imagine going into the SCS with known mechanical issues, especially of the caliber described in this thread. I have absolutely no idea why physicians would be willing to entertain that option and can't help but question the ethics of those doctors. Going forward under those circumstances all but guarantees the failure of the SCS and creates an uphill battle to get anything fixed. It's not cheaper, it's not easier, and it's certainly not going to save any pain or heartache in the end.

    Maybe when I'm further down this road I'm traveling and can look back at my upcoming surgery, having experienced all that comes with it, I will have a better understanding of this idea. But for today, reading these threads is a lot like watching a car sitting on the railroad tracks, knowing that they don't see the train that is barreling down the tracks toward them.
  • Well said.

    >:D<
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  • Thank you!
  • Thank you for your post. I am considering SCS and your post has given me more things to grind before I go ahead with the implant. In fact, some of it actually scares me and my first reaction is to refuse the SCS until I read some of your other posts which told how far you have come due to the SCS.

    Thanks again for your posts!
  • Bionic Woman - your post brought me back to the Dr. circuit as i aptly call it. Sorry i havent been back on the board to thank you in a timely manner. Funny how 4 different docors can come up with 4 different opinions on what i should do with my body.

    I am going with door number 3 please and am going to have a discogram. From there we will see what options i am presented. Sounds like a fun procedure but i am told it will give me more information.

    In the mean time my PM put me on Exalgo. Has anyone had experience with this drug? It makes me very itchy.
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  • Glad my post was of some help, Icarus. I really didn't make it with the intention of scaring anyone away from the SCS, because at the right time, under the right circumstances, I believe it's one of the most incredible tools at our disposal. But like all tools, if you use them at the wrong time or on the wrong job, you're just in for a lot of frustration and failure. Kind of like using a socket wrench on a screw. It just don't work.

    But anyway, I came through here because I wanted to give a quick update on where those dismal conversations with my doctors have ended up.

    Because of the location of my problems, the location of my SCS, and the increased risk of infection associated with both, it will take multiple major surgeries to correct my current problems. If everything goes smoothly, it will take 3 major surgeries over the next 3 months.

    If the SCS weren't involved, it could all be taken care of with a single surgery, but because of the infection risks associated with the SCS and spinal hardware, it has to be spread out to deal with one issue per surgery.

    As I said before, maybe my perspective will change as I go through this process. But, at this moment, I still can't imagine setting yourself up to travel this road on purpose. It's not a choice I would make, personally. There are far too many sneaky little potholes. ;-)

  • I too had a fusion and several ESIs and a laminectomy and just got a SCS last week. So far, the SCS has offered the most pain relief. I am really reluctant to take narcotics out of some fear that I'll follow my injury with a long stay in rehab.I can now tell that I'll probably have to take some pain relievers anyway but probably not nearly as much as I had been taking. I think in my case the fusion was pretty much necessary as my lumbar spine was crushed after an accident. Like many people I was one of the fortunate ones who didn't have paralysis. After the fusion, laminectomy and ESIs (the ESIs didn't work for me at all) I seriously thought I was going to end up in a wheelchair the pain was so bad and I could barely walk (even with a cane). Right now, I am glad I had the SCS but I have not had it very long. Ultimately I think everyone knows their own body best and doctors do the best they can but they have so many patients and not much time to really get to know us (at least in my experience). Good luck!
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