THE PATIENT Back pain relief that lasts for 25 YEARS
A NEW implant for chronic back pain that lasts for 25 years also allows patients to have high-tech scans. Tina Mulchandani, 35, a procurement co-ordinator from London, was one of the first to have it, as she tells ADRIAN MONTI.
Five years ago i began feeling shooting pains down each leg and used my health insurance to have it examined. X-rays and an MRI scan revealed i had a deformity in both hips, probably from birth and i underwent keyhole surgery to repair the joints.
Unfortunately this left me with nerve damage and chronic back pain. i was in constant agony and it really disrupted my life. i was prescribed painkillers — and had physiotherapy but the pain always returned. i even had surgery in May 2015 to try to release whatever was compressing my nerve and causing the pain.
But by the end of last year i was in so much pain i felt like an invalid. i cancelled business trips and often had to work from home. i couldn’t go dancing or swimming, or even walk short distances.
Then in April this year, i went back to see Dr Nigel Kellow, who’d been in charge of my pain management. He told me about spinal cord stimulation, where an implant in the back sends electrical impulses to stop pain signals — the patient can control the electrical pulses using a remote control.
Dr Kellow said he was testing a new, smaller device, which has a special capsule around it so patients can still have MRI scans once it’s fitted — that was important for me because i needed regular MRIS to monitor my hips.
i was slightly scared about anything going wrong near my spine, but keen to try it. Dr Kellow said it could be removed if i didn’t like it. The implant was fitted in August, with a week-long trial to see if i got on with it. The operation was done with a local anaesthetic (i was also sedated); i remember being woken mid-procedure so Dr Kellow could adjust the device’s settings by asking me if i could feel tingling in my legs — a sign that the device worked.
Then i was put back to sleep while the 90-minute procedure was completed. When i woke my back felt slightly uncomfortable where the implant was, but it wasn’t painful. The next day i went home with wires coming out of my back attached to a phone-sized battery.
i used a remote control to alter the frequency but only realised what a big difference the device made when the battery needed recharging after three days. i was at work when i felt a sudden shooting pain down my legs that caught me off guard; i immediately took painkillers. The stimulator battery is recharged via wireless technology.
i went back a week later to have the device fitted properly. The battery and electrodes were inserted under the skin at the top of my buttock; you can see the very slight outline of the battery under my skin but nothing obvious.
i went home next day and was back at work at the end of the week. it’s still early days, but i’m reducing my medication slowly and hope to be off it early next year. Now i’m much happier and more active. i’ve got my life back.
THE SPECIALIST
Dr Nigel Kellow is a consultant in spinal and neurological pain at The Wellington Hospital and Nuada Medical clinic, both in London.
CHRONIC back pain is very common and is often caused by damage to the spinal nerves. The compressed or damaged nerve fires irregular, frequent signals to the brain which responds with pain signals — it’s a protective mechanism.
We can prescribe specific nerve pain medication but these don’t tend to work well for large damaged nerves such as the sciatic and spinal nerves.
We can also try releasing or removing whatever’s compressing the nerve surgically but often this is not enough. Spinal cord stimulators were first developed in the eighties — these work by interrupting and dampening down the irregular signals to the brain, stopping it responding with pain.
Conventional spinal nerve stimulators are bulky and obvious under the skin, and patients often experience a constant tingling feeling as the device emits low frequency signals.
The device batteries also need replacing every five years, which involves additional surgery.
BUT the biggest hindrance is that anyone with a stimulator fitted can never have MRi scans — which are heavily relied on in modern medicine to diagnose and monitor many conditions — because the scanner’s powerful magnetic field would damage the device.
A new spinal stimulator overcomes all these issues — Tina is only the second person in the UK to have one. The Precision Montage is about a third smaller than other devices so is less obtrusive under the skin; and it has rechargeable batteries which last up to 25 years.
Like other stimulators it also comes with a remote control so patients can increase and decrease the signals, but the maximum frequency is higher than other devices so patients don’t feel the constant tingling any more.
it has a casing around the battery to protect it from magnetic rays and the electrode leads are coiled which means they don’t get so hot under an MRi scanner. if they did they could damage the spinal cord.
We fit it in two stages, the first procedure is a trial run to make sure it is suitable for the patient. With the patient under sedation, we make a 6cm incision in the lower back and then wires are fed into the epidural space — between the bone and spinal cord inside the spine — until they reach the faulty nerve.
The patient is then woken so we can test the stimulation. The patient is sedated again so we can tunnel the leads out of the body and connect them to an external battery as a temporary measure.
A week later if the patient is happy with it, we insert the battery and wires under the skin and close the incision properly.
Many NHS hospitals now offer the Precision Montage, including Barts Health and Guy’s and St Thomas’ in London and The Walton Centre in Liverpool.
We’re also getting better results using spinal cord stimulators on patients with back pain without obvious nerve damage: this technology could change how we manage all back pain.
PRECISION MONTAGE costs £32,000 privately.
THE RISKS
AS WITH any surgery, there is a small risk of infection.
ONCE the battery has been fitted under the skin, there is a 10 per cent chance of the leads moving. If this happens, another procedure will be needed to insert them again.
AROUND five per cent of patients need the battery refitted for better comfort.