One program may be for walking, while another may be for sleeping. (Don’t worry, you cannot electrocute yourself. There is a governor that controls how high it can go!) There will also be a series of programs that will be post-operatively customized to different presets – think of these like the channel buttons on the television remote. There will be an “on/off” switch and an “intensity” option with which you will be able to turn the stimulator as high or as low as you desire, like the volume on a remote. This will allow you to play with the settings as much as you want and get an idea of what the real implant would be like. You will be given a remote about the size of a smartphone that will be externally attached to leads. The trial is a close approximation of what it would be like to have an implanted SCS, but without any of the surgical procedure involved in the implant. A spinal cord stimulator trial is completely reversible and an ideal alternative to surgery. The same cannot be said for surgery where the consequences are irreversible and the success rate averages only 61%, with a strong likelihood the symptoms may worsen. Whether the trial is success or not, the patient will be no worse for wear. The elegance of spinal cord stimulation is that one can “test drive” it first. This procedure is ideal for those who are hoping to avoid a painful and invasive spine surgery, as well as those who are not candidate for surgery due to risk or co-morbidities. This allows the patient to test and see if the procedure works before committing to the full version, the implant. The leads are inserted under the skin near the spinal cord for a few days and then removed with only a small Band-Aid to cover the site. The most unique aspect of SCS is the ability to test it temporarily before implanting it permanently – this is called a spinal cord stimulator trial. In the event both fibers are competing to transmit their signals through the spinal cord and into the brain at the same time, the nonpainful signals from the larger fibers will impede the painful signals from the smaller fibers – blocking the sensation of pain. Other non-painful sensations, like the ability to sense light touch and vibration, are transmitted on large, myelinated (the insulation tissue surrounding axons) Aβ. Pain, as it pertains to the Gate Control Theory, is processed and transmitted to the brain through Aδ and C fibers – small, fragile neuron filaments. In other words, one sensation can commandeer the brain’s attention, leaving it unable to process other lesser sensations. Some input can take priority, or even overwhelm other input, thus preventing said input from making it through the spinal cord to the brain for acknowledgement. The concept of SCS was born from a hypothesis by Melzack and Wall in 1965 called the “Gate Control Theory.” The basic essence of this theory is that the nervous system can process only so much input at any given time. Genicular Neurotomy (aka Genicular Nerve Ablation).Endoscopic Discectomy and Microdiscectomy.
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