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Spinal Cord Stimulator

Indication: CRPS, PVD, Low Back Pain, Angina

The spinal cord stimulation (SCS) (dorsal column stimulation) utilizes an electrodes placed in the epidural space, immediately behind the spinal cord, to stimulate the dorsal column of the spinal cord. The exact mechanism of SCS is unclear. However, it is believed that the gate-control theory of pain conduction plays a major role. When the dorsal column of the spinal cord is stimulated, it may attenuate the conduction of the pain signal on the spinothalamic tract through collateral inhibition. Inhibitory neurotransmitters such as gamma-aminobutyric acid (GABA) may also be involved.

SCS is indicated for failed back surgery syndrome, complex regional syndrome, and unremitting pain due to peripheral vascular disease. Recent studies have indicated that SCS may also improve pain caused by a refractory angina and improve circulation in the coronary arteries. Some authors have reported treatment of severe peripheral neuropathy and post-herpetic neuralgia with SCS. The value of SCS for amputation stump pain, phantom limb pain and spinal cord injury is yet to be established. Patients seeking spinal cord stimulator treatments usually have failed all the other conservative treatments, such as medication, physical therapy, and nerve blocks with anesthetics and/or corticosteroids. The spinal cord stimulator is not indicated for severe depression.

Patients should have a SCS trial prior to permanent implantation. During the trial, a percutaneous lead is inserted through the skin into the epidural space. Once the tip of the lead reaches the appropriate level, it is connected to an external pulse generator. When the stimulator is turned on, the patient feels tingling and numbness. If the painful area is covered by the stimulation, the pain is decreased by more than 50% and the patient is satisfied with the stimulation, a permanent implantation may be considered. The procedure of permanent implantation of the SCS is performed by pain specialists or neurosurgeons in operating room.

It requires a percutaneous insertion of an electrode into the epidural space under the guidance of fluoroscopy. The tip electrode is threaded up to T9 to T11 level in the epidural space immediately behind the dorsal column for the treatment of low back and leg pain. The other end of the electrode is connected through a subcutaneous tunnel to an internal pulse generator buried under the skin in the low back or abdominal wall. The strength of the stimulation can be changed through a remote control. Common complications of spinal cord stimulator implantation include infection, moving of the electrodes, and failure of pain relief, even after a “satisfied” trial. Serious complications, such as spinal cord compression, or epidural abscesses are rare.

Meet the FLPNR Team

  • Richard Adkins, MD
  • Hoang (Wayne) T. Vu, D.O.
  • Lourdes Varela–Batista, M.D.
  • Vinh-Loc Nguyen, P.A.
  • Irene Aponte Moreno, N.P.
  • Sunny Park, N.P.
Anesthesiology Specialist in Ocala, FL Doctor of Osteopathic Medicine in Ocala, FL Physician in Ocala, FL Physician in Ocala, FL Nurse Practitioner in Ocala, FL Nurse Practitioner in Ocala, FL
Anesthesiology Specialist in Ocala, FL

Richard Adkins, MD

Anesthesiology Specialist

Dr. Richard Adkins has been in practice for more than 30 years. His specialty is in anesthesiology and pain medicine.

Doctor of Osteopathic Medicine in Ocala, FL

Hoang (Wayne) T. Vu, D.O.

Dr. Hoang (Wayne) T. Vu is board certified by both the American Board of Pain Medicine and the American Board of Physical Medicine and Rehabilitation. Dr. Vu earned his degree of Doctor of Osteopathic Medicine from Touro University College of Osteopathic Medicine in California in 2003.

Physician in Ocala, FL

Lourdes Varela–Batista, M.D.

Dr. Varela is a fellowship trained pain specialist and board certified PMR expert. Her specialities include physical medicine and rehabilitation and interventional pain medicine. She received her undergraduate degree from University of Puerto Rico and completed her medical degree from New York Medica College. Dr. Varela completed her physical medicine and rehabilitation residency at University of Texas Health Science Center San Antonio.

Physician in Ocala, FL

Vinh-Loc Nguyen, P.A.

Vinh-Loc Nguyen is a NCCPA certified physician assistant and is licensed by the State of Florida Department of Health. He received his Bachelor of Science degree in microbiology and Bachelor of Arts Degree in economics from University of Florida in 1994. He had a successful career in the financial industry before returning to his true passion for medicine.

Nurse Practitioner in Ocala, FL

Irene Aponte Moreno, N.P.

Ms. Irene Aponte Moreno is an Adult-Gerontology certified Nurse Practitioner and licensed by the State of Florida Department of Health. In 2014, she received her Master of Science degree in Nursing from the University of South Alabama. She completed her Bachelor of Science degree in Nursing from Jacksonville State University in December of 2006. In 2003, she received an Associates of Arts degree from Southwestern Michigan College. She also completed an Associate degree in Informatics from the University Institute Antonio Jose de Sucre located in Lara State, Venezuela.

Nurse Practitioner in Ocala, FL

Sunny Park, N.P.

Ms. Sunny Park is an AANP and ANCC certified Advanced Registered Nurse Practitioner, licensed by the State of Florida Department of Health. She graduated with Summa Cum Laude with Bachelor of Arts in Drawing from Southern Illinois University in 1999. She pursued nursing career and graduated with Associate of Science in Nursing in 2007 and started working as a registered nurse in Cardiovascular ICU in St.Luke’s Medical Center. She continued with her education and graduated with Magna Cum Laude obtaining Bachelor of Science in Nursing in 2010 from Cardinal Stritch University. During her nursing education, she was awarded multiple scholarships including the Lamplight scholarship by Milwaukee Nurses Association.


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