Overview
The multifidus is a group of small, deep muscles along your spine. They help keep the lower back steady when you move. In some people with long-lasting low back pain, these muscles stop working well, and the back loses some of its natural control. Restorative neurostimulation with ReActiv8 is an implanted system that sends mild electrical signals to the nerve that controls the multifidus. This makes the muscle tighten and relax in a set pattern, a bit like exercise you cannot do on your own. Over time, this is meant to help the muscle work better. It may help some people with long-lasting low back pain who have not improved with therapy and who are not able to have back surgery.
What it is
ReActiv8 is made by Mainstay Medical. Unlike spinal cord stimulation, which is designed to change how pain signals reach the brain, restorative neurostimulation is designed to help a weak or poorly controlled muscle work again.
The system has two thin leads placed near the nerves that control the multifidus muscle on each side of the lower spine, and a small battery-powered generator placed under the skin. You start each session with a handheld remote, usually twice a day for about 30 minutes while lying down. During a session, you may feel the muscles in your lower back tighten and relax.
There is no trial phase for this therapy. The benefit, if it comes, builds over weeks to months as the muscle retrains, so a short trial would not show whether it helps.
Who it's for
ReActiv8 may help adults who have:
- Chronic mechanical low back pain, meaning pain that comes from the structures of the back and is often worse with certain movements or positions
- Signs of multifidus muscle dysfunction on imaging or exam
- Pain that has not improved with physical therapy and pain medicines
- No good option for back surgery (they are not a surgical candidate)
What the procedure involves, step by step
- Evaluation: we review your history, exam and imaging, and look for signs of multifidus dysfunction. We also check that your pain is not mainly from a pinched nerve or another cause.
- Before the procedure: we review your medicines, including blood thinners, and your overall health.
- Implant: the procedure is done as an outpatient with anesthesia. Through small incisions in the lower back, and with live X-ray guidance, two leads are placed near the nerves that control the multifidus.
- Generator: the leads connect to a small generator placed under the skin, usually in the lower back or upper buttock area.
- Going home: most people go home the same day.
- Starting therapy: after healing, the system is turned on and set up. You learn how to start your daily sessions with the remote.
Recovery and what to expect
- Soreness at the incisions for one to two weeks is common.
- You will usually limit bending, twisting and heavy lifting for several weeks while you heal.
- Daily sessions are an important part of the therapy. Skipping sessions may reduce any benefit.
- Changes, if they happen, tend to build slowly over months. Some people notice improvement, and some do not.
- Many current systems allow MRI scans only under specific conditions. Always tell other providers you have an implant.
Candidacy: who may or may not be a good fit
May be a good fit: adults with chronic mechanical low back pain linked to multifidus dysfunction who have not improved with physical therapy and medicines, and who are not candidates for spine surgery.
May not be a good fit: people whose main pain travels down the leg (such as sciatica), people with a back problem that needs surgery, an active infection, a bleeding problem, certain other implanted electrical devices, or who cannot commit to daily sessions. Your exam and imaging decide whether this option fits you.
Risks in brief
Risks include infection, bleeding, pain or discomfort at the incisions or generator site, lead movement or breakage, device problems and the need for another procedure. Some people feel the muscle contractions are uncomfortable until settings are adjusted. Pain may not improve. Anesthesia also carries risks.
Alternatives
Other options may include a guided exercise and physical therapy program, medicines, radiofrequency ablation for facet joint pain, Intracept for vertebrogenic pain, spinal cord stimulation or a surgical opinion.
Frequently asked questions
How is ReActiv8 different from spinal cord stimulation?
Spinal cord stimulation is designed to change how pain signals reach the brain. ReActiv8 is designed to make the multifidus muscle contract, to help it regain control of the lower back.
Why is there no trial?
Any benefit builds slowly over weeks to months as the muscle retrains. A short trial would not show whether the therapy may help.
What does a session feel like?
Most people feel the muscles in the lower back tighten and relax. Sessions are usually done lying down, twice a day for about 30 minutes.
How soon might I notice a change?
It varies. Changes, if they happen, tend to build over months. Some people do not improve.
Can I have an MRI?
MRI may be possible only under specific conditions. Ask your physician before any MRI.
Can the system be removed?
Yes. The system can be turned off or removed if needed.
Insurance
GSMC participates with all Aetna plans, including Aetna HMO, and with many other insurance plans. Coverage for a specific procedure depends on your plan and may need prior authorization; call 732-202-3000 to verify. Our team can help check your benefits before treatment.
Book an appointment
One phone number for all 7 GSMC offices in Ocean and Monmouth County.
Our offices
- Whiting
- Toms River (1314 Hooper Ave)
- Brick
- Barnegat
- Manahawkin
- Freehold (322 Professional View Dr)
- West Long Branch
Telehealth visits are available for second opinions and imaging reviews only, by phone. Please call 732-202-3000 to book one.
This page is general patient education and does not replace advice from your own clinician. Individual results vary, and no outcome can be promised.