Procedures performed:

• Surgical Implantation of Spinal Cord Stimulator

Originating from a computer controlled generator, electrodes placed in the spinal canal deliver low levels of electrical energy over the dorsal columns of the spinal cord. This area of the spinal cord conveys the sensation of pain to the brain. Stimulation interrupts this signal, so that pain is no longer perceived. Both generator and electrodes (contained in insulated leads) are implanted during surgical procedure. Rechargeable as well as standard generators are now available. Surgical implantation is done only after a successful trialing procedure. Success is defined by both signicant (greater than 50% from baseline) pain relief, and by improvement in physical activity functional status

• Intrathecal Medication Trial

Intrathecal medication trials are performed, injecting via single bolus, or by delivery via catheter placed for trial, for a defined period to see how the patient tolerates medication being tested. This is done prior to permanent pump implantation, to determine type of medication to be used, as well as to establish initial dosing.

• Surgical Implantation of Intrathecal Medication Delivery Pump

Computer controlled, fully programmable pump delivers medication via intrathecal catheter, directly into fluid surrounding the spinal cord. Catheter and pump are implanted during a surgical procedure. Medication in the pump is refilled periodically (e.g. monthly) by injecting medication through the skin into pump port reservoir. Type of medication used can be changed. Medications can be added to mixture, and/or removed.