Dr. Le, who has more than 25 years’ experience in pain management and special expertise in epidural injections, facet joint nerve ablations and sacroiliac joint interventions, says SCS has been in use for more than 40 years. Closed loop SCS technology, however, just approved last year, has made the treatment even more convenient and effective for reducing chronic pain, he says.
Approved for treating patients with diabetic neuropathy
Seif Elbualy, M.D., director of the pain management division of Marcus Neuroscience Institute, says SCS has been used for years at Marcus Neuroscience Institute to treat a variety of painful conditions, including post-laminectomy syndrome, or failed back syndrome. Two years ago, the technology was also approved for use in treating diabetic neuropathy.
According to the U.S. Centers for Disease Control and Prevention (CDC), half of all people with diabetes sustain nerve damage, called diabetic neuropathy. “High blood sugar damages the nerves, and these nerves may stop sending messages to different parts of your body. Nerve damage can cause health problems ranging from mild numbness to pain that makes it hard to do normal activities,” the CDC states.
Constant feedback allows device to self-adjust in real time
Closed loop SCS technology, which was just approved for use last year, represents a significant advance, Dr. Le says, because “now the signal is a two-way street and the device is able to self-adjust its stimulation level output in real time, based on the feedback it is constantly receiving.”
With closed loop SCS, Dr. Le explains, the stimulator sends a signal to the spinal cord and receives feedback via a return signal generated 100 times per second. “That signal tells the device how effective the stimulation is so that it can automatically adjust its output as needed,” he says. “Before, we could only set the system to a certain level and then occasionally have to manually adjust it. Now the closed loop device automatically adjusts the setting based on what the patient requires at any given time.”
Marcus Neuroscience Institute is the only hospital-based program in the state to offer the closed loop SCS technology, says Dr. Elbualy, who has performed a number of these procedures since its approval last year and hundreds of traditional SCS procedures over the course of his career.
Trial run allows patients to “test drive” SCS technology
An essential first step before permanently implanting an SCS device is a five- to seven-day trial run, Dr. Le says. It involves an easy outpatient procedure – only local anesthesia required, with no surgery – in which electrodes are temporarily placed into the spine through the skin and are easily pulled out at the end of the trial period.
The patient is able to “test drive” the device 24 hours a day in all of their normal daily activities at home or work to see if it has any effect on their pain, says Dr. Le. “The trial run is considered successful if the patient experiences at least a 50 percent decrease in pain or in the use of pain medications, or on the flip side a 50 percent improvement in function,” says Dr. Le. “If they report relief during the trial run and opt for a more permanent solution, we proceed with the implantation of the generator and new leads so that it can be a fully self-contained system.”
Patients usually notice improvement within a day or two
Both traditional and closed loop SCS are outpatient procedures that usually take less than an hour. In either procedure, usually performed by Timothy Miller, M.D., a neurosurgeon and spinal surgeon with Marcus Neuroscience Institute, electrodes are permanently implanted in the epidural space of the spinal column via a small incision.
A separate small incision allows for implantation of the generator, a device roughly the size of a pacemaker that powers the electrodes. “The generator can be rechargeable or non-rechargeable,” Dr. Le says. “A rechargeable generator generally lasts longer before eventually having to be replaced. When the battery runs out, we simply replace it with a new battery.”
Dr. Le says patients experience “minimal incisional pain” at the site of the implant for a few days and any discomfort gets progressively better with time. Once the system is activated, patients usually start noticing an improvement in their chronic pain within just a day or two.
Once the system has been implanted, the patient will need occasional follow-ups in order to reprogram the device, which can be done in the doctor’s office or even at the patient’s home, says Dr. Le. He adds that from his experience, patients frequently report better outcomes with closed loop SCS stimulators and that the number of visits needed for reprogramming these systems is less than it has been for traditional SCS stimulators.
A comprehensive approach to neurologic care
Aside from the distinction of being the only hospital-based program in Florida to offer the new closed loop SCS technology, Dr. Le says that one of the most important advantages Marcus Neuroscience Institute offers is its comprehensive approach to neurologic care.
“Patients here are cared for by a multidisciplinary team of neurosurgeons, neurologists, pain management physicians and other specialists who handle all types of neurological disorders and work collaboratively to help patients find relief from their chronic pain,” Dr. Le says. “This approach not only makes more sense from a care perspective, it also has been shown to improve patient outcomes.”