Minimally Invasive Spine

What is Neuromodulation?

Normal neural activity functions within an intricate balance of electrical and chemical signals that can be impacted by genetic, chemical, or physical trauma-related factors to the nervous system.  Neuromodulation therapies target areas of the nervous system with the delivery of modifying agents, including electrical, optical, or chemical signals, directly to the source of the condition to beneficially alter the way pathologic tissues behave and improve neural function.  Such therapies include:

• Spinal cord stimulation (SCS)
• High Frequency (HF10) SCS
• Burst SCS
• High Density (HD) SCS
• ECAP - Closed Loop SCS
• Dorsal root ganglion (DRG) stimulation
• Peripheral nerve stimulation (PNS)
• Intrathecal drug delivery system (IDDS)

The most common form of neuromodulation therapy is spinal cord stimulation (SCS) to treat chronic pain while a number of neuromodulation therapies are utilized for treatment of ischemic disorders (angina, peripheral vascular disease), hypertension, epilepsy, obesity, depression, GI disorders, pelvic disorders, incontinence, dystonia, Parkinson’s disease, Tourette syndrome, essential tremor, among others.  

SCS therapy involves the application of micro-currents of electricity to specific target regions of the spinal cord, altering the perception of pain. With innovation in the field the last 10-15 years, SCS has become a potentially customizable form of treatment when in previous years, there was minimal variability in using electrical impulses along a nerve or set of nerves for pain relief.

Peripheral nerve stimulation (PNS) has been used for the treatment of a variety of neuropathic pain conditions, including occipital nerve stimulation, vagus nerve stimulation, sacral nerve stimulation, peripheral field stimulation, among others. Neuromodulation technologies also include intrathecal drug delivery systems that continuously deliver pharmaceutical agents directly to the source of the condition, with desired targets in the spinal cord or brain.

What are the Benefits of Neuromodulation?

Neuromodulation therapies improve lives and provide an alternative to long-term medication therapy for symptomatic relief of chronic conditions.  Spinal cord stimulation (SCS), a form of neuromodulation, is a proven, minimally invasive, effective treatment option for a variety of chronic pain indications that may obviate the need for medications or invasive surgery.   

For intrathecal drug delivery systems that continuously deliver pharmaceutical agents directly to the targets in the spinal cord or brain, this method of medication delivery directly into the central nervous system lowers the effective dosage and decreases or avoids most side effects associated with more systemic medical management approaches that can lead to long-term tolerance development, addition, and toxicity. Several studies showing the early use of neuromodulation technologies is also more cost-effective at controlling certain conditions, including, cancer-related pain, neuropathic pain, chronic pain, and spasticity.

Another advantage of SCS for patients includes the ability to control their pain by using a remote control to turn the device on or off, select different therapeutic programs, or control the stimulation personalized to their specific needs.  For intrathecal drug delivery systems, patients can also select timed delivery based on physician-guided treatment programs.

Before considering surgery, Dr. Huang-Lionnet of Greenwich Health uses the most appropriate, conservative forms of interventional pain and neuromodulation-based treatments where they may be effective. Our team at Greenwich Health also work with our referral network of leading, highly trained neurosurgeons and orthopedic surgeons, when potential surgery may be indicated.

How are Neuromodulation Trials Carried Out?

Unique to neuromodulation therapy, patients can trial the device to confirm positive response prior to proceeding with a permanent procedure.  After obtaining a psychological evaluation to screen for conditions that can limit the therapy’s effectiveness, a trial would be performed before the permanent placement and typically lasts five to ten days. The interventional pain physician would place wire(s) (referred to as leads) into the epidural space and steer(s) these to lie over the specific areas of the spinal cord that correlate with the targeted areas of pain symptomatology.  

Once location is confirmed, the leads would be secured to the skin. A temporary external pulse generator (battery) will be attached to the end of the lead that’s outside the body and programmed to provide different potential SCS settings to optimize the stimulation pattern that best attenuates your pain.  

During the trial period, you will be encouraged to track whether the stimulation relieves the pain and to monitor its impact on your ability to perform normal activities of daily living.  After the trial period, we would jointly discuss and make a decision whether it makes sense to have the device permanently implanted. With a successful trial, minimally invasive spinal surgeries involving permanent placement of the neuromodulation technology (SCS or intrathecal drug delivery systems) would be performed with our expert functional neurosurgery or spine surgery colleagues.  Such treatments would be performed at a hospital setting with the potential to go home after 23-hour observation post-procedure.

For various sources of chronic pain or dysfunction in your body, Dr. Huang-Lionnet can help you find non-opioid alternatives to achieving relief, restore your function, and improve your overall health using the most up-to-date techniques. Call Greenwich Health today, or book an appointment online.