Wireless implanted stimulators are devices that send low electricity levels directly to the spinal cord for pain relief. These devices are made up of electrodes (which are thin wires) and a generator (a small battery pack).
These electrodes are placed in between the vertebrae and spinal cord. Then the generator is put under the skin close to the abdomen or buttocks. The simulator allows the patients to send electrical impulses with a remote control whenever they are feeling pains. Both the antenna and remote control are usually outside the body.
The mechanism supporting spinal cord stimulation is still very much understudy. However, certainly, it can directly target different muscle groups from the spine and alter how the brain perceives pain.
The traditional stimulators can replace pain sensation with slight tingling, which is called paresthesia. Some patients find this uncomfortable. However, there are newer technology and devices that give sub-perception stimulation which the patient does not feel. These devices are often placed by trained physicians, especially under ultrasound and/or X-ray guidance in the field of interventional pain management.
Uses for spinal cord stimulation
The purpose of spinal cord stimulation is to serve as an alternative option for treating pain, especially after other nonsurgical options fail to provide the needed relief from pain. In addition, these simulators may be used for treating or managing chronic pain of different types such as:
- Back pain (failed back surgery syndrome), especially when the pain fails to go after surgery.
- Post-surgical pain
- Heart pain that cannot be treated by other means
- Arachnoiditis is a painful inflammation around the arachnoid (a small membrane covering the spinal cord and brain).
- Spinal cord injuries
- Pain after amputation
- Peripheral vascular disease
- Perineal pain and visceral abdominal pain
- Nerve-related pain like cancer-related neuropathy caused by chemotherapy, surgery, or radiation, and severe diabetic neuropathy.
- Complex regional pain syndrome
Types of spinal cord stimulators
There are three main types of spinal cord stimulators. These are:
- Conventional implantable pulse generator: this spinal cord stimulator is powered by a battery placed within the spine during a surgical operation. When the battery runs out, there has to be another surgery to replace the battery. Therefore, this device is an ideal choice for people who feel pain in just one part of their body because of its low electrical output.
- Rechargeable IPG: this stimulator works similarly to the conventional one. But the difference is that it is possible to recharge the battery without carrying out another surgery. This is because it uses a rechargeable energy source, so it can give us more electrical output. This simulator is a good choice for people who feel pain in their lower back or pain in either of the legs because it has a high electrical signal that can reach further.
- Radiofrequency stimulator: this stimulator type uses a battery that is placed outside of the body. However, it is not used commonly today because there are newer designs that use better technology. The batteries are also rechargeable. Like IPGs, it is also a good choice for people who have pain in their legs or lower back because of its high power.
The surgeon is responsible for explaining the device’s operation and adjusting the electric signal intensity appropriate for each of the stimulator types. Also, different positions of the body may need different stimulator settings. For instance, there’s a setting that is more appropriate for walking and another one for sitting. To access the best settings easily, most of these devices are made to have two to three preset programs. However, newer devices have several waveforms to deliver electricity, including burst, high density, and high-frequency stimulation.
Wireless implanted stimulators
One of these new wireless implanted stimulation devices was invented by Rice University researchers. These researchers developed new implants in patients with spinal cord injuries to provide them with electrical stimulations. The new research also looks into program multisite stimulators with just one transmitter, which is placed outside the body. This transmitter can be worn potentially on the belt and can offer power and programming for more than one implant within 2-3 inches distance.
It is also possible to program these implants with delays measured in microseconds to enable the device to trigger and coordinate several wireless pacemakers in different chambers of the receiver’s heart. This team of researchers showed a possibility for the implants to be programmed to stimulate in a well-coordinated pattern and synchronize other devices.
These researchers also showed that synchronization allows for a greater level of freedom during the stimulation treatments, whether used to treat spinal cord injuries or for cardiac pacing. They tested some implants at the lab, which were about the weight and size of a vitamin. They were tested on rodents and tissue samples of live hydra Vulgaris. Their experiment showed that these devices could stimulate two different hydrae over short distances to activate fluorescence tags to respond to electric signs.
These implants could also trigger responses at controlled amplitudes along the sciatic nerves of a rodent. The device created by the lab is called Magni, which in long-form translates to main electrical neural implants. These implants were created as spinal cord stimulators that don’t require wires for power and program. The absence of cables means that patients no longer have to suffer lead poking through their skin, which reduces the risk of getting an infection.
The current devices used to divide the stimulation are powered by a battery, which has to be replaced every few years through a surgical process. The refining process is still ongoing, and researchers at Rice University are continuing the development.
Stimulator implantation for spinal cords
While the procedure for permanent implantation is ongoing, the generator is put just under the skin while sterile electrodes are used to replace trial electrodes. However, unlike trial electrodes, there will be sutures to anchor the sterile electrodes to minimize movement. This implantation only takes about 1 or 2 hours and is usually done as an outpatient practice.
After administering the local anesthesia, the surgeon will make an incision along the buttocks or lower abdomen, holding the generator. They will also make another incision along the spine, which will be for inserting the permanent electrodes. These incisions are usually around the same length as a driver’s license. Fluoroscopy is also used during this procedure to determine the placement of the electrodes.
Once the generator and the electrodes have been connected and are running, the surgeon will close up the incisions. The surgeon may provide the patient with sedation to be comfortable, and they may also ask for their feedback during and after placing the electrodes.
There are many positives to come from spinal cord stimulations. It can improve sleep quality and overall life quality and reduce the need to take pain medicines. Typically, it is used alongside other treatments for pain, such as physical therapy, exercise, relaxation methods, medications, etc.
The creation of wireless implanted stimulators will even make spinal cord stimulations more effective and require fewer surgeries. In addition, the research carried out into these wireless stimulation also ensures that the device can use a transmitter put outside the body for multisite programming stimulators.
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