Spinal Cord Stimulator Implantation: Protecting the Cord at All Costs

Severe back or pain is one of the more debilitating conditions facing many Americans today. Lower back pain pain, which starts below the ribcage, is called lumbar back pain. Mid-back pain, centrally located, is called thoracic back pain. Neck pain is often referred to as cervical pain. Sometimes this pain comes on suddenly (acutely) following an injury from an athletic activity or fall. In other cases, the pain comes on slowly and lasts for months and months, if not years. In many of these instances, the pain is caused either by degeneration of the spinal cord discs. Spinal cord discs are gel-like spacers that occupy the spaces between the spinal cord vertebrae. These discs are prone to wear and tear from injuries or from mere aging. As these discs weaken, the discs can bulge out of the normal disc space, or even rupture, which in turn, puts pressure on the spinal nerve roots that run through the back region. Discs that extend slightly outside that normal disc space are often called “bulging” or “herniated” discs. Intense pain often results when these herniated/bulging discs put pressure on the surrounding nerve roots. In many instances, the pain can radiate into a person’s buttocks or down into their legs. In severe cases, the herniation can result in loss of bowel or bladder control, leg weakness or even paralysis.

Initially, back pain is treated conservatively with over the counter pain medications or even prescription pain medications or muscle relaxants. If those treatments fail, your orthopedic surgeon or neurosurgeon may recommend you for what is known as a spinal cord stimulator. A spinal cord stimulator is a device that uses an electrical current to treat chronic pain. Essentially a small pulse generator is used to send electrical pulses to the spinal cord in an attempt to interfere with the nerve impulses that make you feel pain. Typically, doctors will first insert a temporary electrode into your body as a trial. That electrode is controlled by the patient with a hand-held stimulator. If the trial proves successful, the physician will typically implant a permanent stimulator under your skin.

During the course of the spinal cord stimulator implantation procedure, the physician inserts “leads”, paddle shaped device containing the electrodes, into the spinal canal, just above the spinal cord. That space is called the spinal epidural space (the outermost area of the spinal canal). The leads are inserted either through what is called a percutaneous approach (utilizing a wide bore needle to insert the paddle lead into the epidural space) or through a surgical laminectomy/laminotomy procedure (where the vertebrae at the affected level is temporarily removed so as to gain access to the epidural space through an incision in the ligament that protects the spinal cord. The paddle leads are then sutured in place and a generator (battery) is implanted in the patient’s side and connected to the leads. The spinal cord stimulator implantation procedure, while common, carries a high degree of risk of spinal cord injury, including paralysis, loss of bowel/bladder function, etc.

The cardinal rule for all surgeons when implanting a spinal cord stimulator is to protect the spinal cord at all costs. The epidural space is millimeters wide with the spinal cord lying immediately below it. The spinal cord itself, is essentially the consistency of wet pasta, and therefore, can be easily injured if contacted by surgical instruments or the paddle leads with any degree of force. Many patients have what is called “scar tissue” in their epidural space. Scar tissue can result from a prior injury at the level of the cord or if a previous lead had been placed in the area and now needs to come out. Scar tissue often blocks the intended pathway for the paddle leads and makes their implantation difficult. In order to properly place the paddle leads, the surgeon must first free up the scar tissue or gently push the paddle leads through the scar tissue to reach the intended location. In many cases, the surgeon will negligently injure the spinal cord while attempting to free up the scar tissue (either by a surgical instrument) or by pushing the paddle lead into the cord itself (instead of the epidural space). Accordingly, when a surgeon encounters scar tissue, the standard of care requires the surgeon to either convert the procedure from a percutaneous one to an open procedure to better visualize the adhesions, or extend the laminectomy to the area of the adhesions (sometimes the adhesions are located further along the epidural space than the incision that is made in the ligament) to better see what he/she is doing. Failure to do so can cause serious injury and lead to a medical malpractice lawsuit.

At STSW, our lawyers have handled a number of cases in the Baltimore, Maryland and Washington D.C. region in which an orthopedic surgeon or neurosurgeon has negligently injured the spinal cord while implanting a spinal cord stimulator. If you or a loved one have suffered a permanent neurological injury following a spinal cord stimulator implantation procedure, call our team for a free consultation at (410) 385-2225.