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Spinal Cord Stimulator for Diabetic Neuropathy

Finally, relief from painful diabetic neuropathy.

Patients walking in park after spinal cord stimulator for diabetic neuropathy

Get relief from painful diabetic neuropathy. At ProVascularMD, we now provide spinal cord stimulator surgery to help you overcome debilitating pain caused by diabetes. Read this quick overview from our diabetic neuropathy specialists to learn more about spinal cord stimulator devices, how they work in diabetic neuropathy, and what to expect when you undergo treatment with a spinal cord stimulator. If you have any further questions about spinal cord stimulation or painful diabetic neuropathy, get in touch with us at ProVascularMD in Los Angeles or our other Southern California locations. We look forward to hearing from you.

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Painful diabetic neuropathy specialist Dr. Michael Lalezarian in Los Angeles, California

Painful Diabetic Neuropathy Specialist

Dr. Michael Lalezarian

Painful diabetic neuropathy? We can help you find relief.

Dr. Michael Lalezarian is a double-board certified Vascular Interventional Radiologist specializing in neuromodulation therapy for painful diabetic neuropathy, including spinal cord stimulation. He is a committed partner in the battle against the devastating consequences of diabetes.

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“I was referred to Dr. Lalezarian from my orthopedic surgeon for varicose vein treatment options. From the second I walked into the office, I was at ease and felt very welcomed from Kimberly and the staff. Upon meeting the doctor, he was so kind and fully explained my options after the initial ultrasound on both legs. I decided to go with the sclerotherapy and am so happy that I did. The procedures were quick and virtually painless but the results are life changing for me. The pain suffered for so many years and countless sleepless nights are a thing of the past.”

Vickie W, March 2022

What is a Spinal Cord Stimulator?

In many ways, your spine is the central nervous highway of your body. It is responsible for carrying all manner of neurological signals from your body to your brain, and from your brain to your body. Painful sensations are communicated through the spine, including pain caused by diabetic neuropathy. A spinal cord stimulator is a medical device that delivers electrical energy to the spine, therefore interrupting pain signals before they reach the brain.

When you receive a spinal cord stimulator for diabetic nephropathy, electrical stimulation is delivered to your spine by way of leads that are connected to an implantable pulse generator (an IPG) by small wires. Leads are specially designed electrical contacts that are placed near the spine. Electrical signals are sent to the leads by the IPG, which is a battery-powered micro-electronic device that can be programmed to deliver specific patterns of electrical stimulation. The IPG is controlled by an external remote control, which can be used to modify stimulation patterns, intensity, and other settings. [1]

At a glance, a spinal cord stimulator device looks quite similar to a cardiac pacemaker, but a spinal cord stimulator has special features that are designed specifically for the spine and for pain therapy.

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Spinal cord stimulator device for diabetic neuropathy

Spinal cord stimulator device.

How Does Spinal Cord Stimulation Work in Diabetic Neuropathy?

Diabetic neuropathy is a condition in which nerves in the arms, hands, legs, feet, and other regions of the body are damaged by chronic, uncontrolled diabetes. Pain signals originate in the peripheral extremities and are communicated to the spine through specialized nerve fibers called A beta, A delta, and C fibers. From the spine, the signals are integrated and sent to the brain where they are processed and perceived. Damage to peripheral nerves can cause severe pain signaling even when there is no identifiable source of pain. [2]

A spinal cord stimulator works by creating an electric field near the nerves along the spine. This electric field interferes with the electrical activity of the nerves that are involved with pain signaling to the brain. When the spinal cord stimulator is active, painful sensations are replaced with a mild tingling sensation. [3]

An important advantage of a spinal cord stimulator is that it can be personalized to your pain patterns and sensory preferences. With an external remote control, the electrical energy can be targeted towards specific parts of your spine, delivered in different patterns, amplified, or reduced with the press of a few buttons. [1]

Spinal Cord Stimulator Surgery: What to Expect

Unlike most medical procedures, spinal cord stimulator surgery requires two separate procedures. The first is a trial procedure, which is designed to help you decide whether or not the spinal cord stimulator provides you with pain relief. The second is the implant procedure, which only takes place if you experienced pain relief during the trial.

Spinal Cord Stimulator Trial

The spinal cord stimulator trial can be thought of as a test drive of the implantable device. Not every diabetic neuropathy patient finds pain relief when treated with spinal cord stimulation, so the trial is standard practice to ensure that a long-term device implant makes sense for you. While the spinal cord stimulator device is not fully implanted during the trial, the leads are inserted into your body and connected to an external pulse generator.

The trial procedure is done with the patient lying face down. A small incision is made on the back under local anesthesia, and a hollow needle is inserted into the incision and guided towards the treatment area. An X-ray is used to visualize the anatomy and direct the placement of the needle into the epidural space of the spinal canal. The leads (wires) are passed through the hollow needle and attached to the treatment area.

After the leads are placed, the spinal cord stimulator is turned on, allowing the patient to experience the sensation of the stimulator. The surgeon will ask the patient if the stimulation is hitting the right areas where pain is frequent, and will adjust the stimulation settings until the patient agrees that the settings are sufficient.

During recovery, the patient will then receive a brief demonstration on how to adjust the stimulation settings. The patient is sent home on the same day, beginning the trial period. Around 7 days later, a decision is made on whether or not to proceed with the final spinal cord stimulator implant. If the patient does not wish to proceed with the implant, the leads will be removed at the conclusion of the trial period.

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Spinal cord stimulator implant for diabetic neuropathy

Spinal Cord Stimulator Implant

If the trial is successful, the external stimulator will be replaced with the implantable spinal cord stimulator. The method of inserting the leads is similar to that described above, however additional steps may be required to permanently attach the electrodes to the treatment area. Following electrode placement, the patient is sedated and a small incision is made to insert the IPG. Depending on the patient’s anatomy and preferences, the IPG is implanted near the abdomen, the upper buttocks, or upper chest.

Spinal Cord Stimulator Recovery

It is normal to experience pain following the implant procedure, particularly at incision sites, where the IPG was placed, or where the hollow needle was inserted. [1] In some cases, patients may be advised to avoid activating their spinal cord stimulator until swelling subsides. Spinal cord stimulator surgery is an outpatient procedure, so patients are typically discharged the same day. In most cases, patients can gradually increase activity after two to three weeks, but complete recovery from surgery may take up to eight weeks, and certain activities may be restricted even longer to avoid disrupting the components of the spinal cord stimulator.
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Spinal Cord Stimulator for Diabetic Neuropathy

What is a spinal cord stimulator? How does it work? What to expect when you get one.
Los Angeles Diabetic Neuropathy Specialist Dr. Michael Lalezarian

Diabetic Neuropathy Specialist in Los Angeles

Learn more about Los Angeles Diabetic Neuropathy Specialist Dr. Michael Lalezarian.
References

[1] Kreis, P. G., Pritzlaff, S. G., Copenhaver, D. J., & Fishman, S. (2023). Spinal Cord Stimulation: Percutaneous Implantation Techniques. Oxford University Press, Incorporated.
[2] Feldman, E.L., Callaghan, B.C., Pop-Busui, R. et al. Diabetic neuropathy. Nat Rev Dis Primers 5, 41 (2019). https://doi.org/10.1038/s41572-019-0092-1
[3] Sdrulla, A.D., Guan, Y. and Raja, S.N. (2018), Spinal Cord Stimulation: Clinical Efficacy and Potential Mechanisms. Pain Pract, 18: 1048-1067. https://doi.org/10.1111/papr.12692

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