Spinal Cord Stimulator

A spinal cord stimulator (SCS) is a medical device that a surgeon implants in your body to help treat severe pain.

Your healthcare provider will usually suggest other, nonsurgical treatments, like physical therapy and medications, before a spinal cord stimulator. But an SCS may be a good option if other treatments haven’t worked or it’s not safe for you to take certain medications, like opioids.

How does a spinal cord stimulator work?

A spinal cord stimulator works by toning down chronic pain signals in your body. Pain signals are electrical currents that start in your nerves, travel along your spinal cord and up to your brain. Your brain translates these electrical signals into the pain you feel. An SCS emits a safe, alternate electrical current into your spinal cord that you can control. This other current can block the chronic pain signals and help your brain ignore them.

A spinal cord stimulator is like a really good white noise machine. The hum of a sound you choose to turn on in a room can block out annoying noises you don’t want to hear. It doesn’t eliminate the problem (the pain signals), but it helps you and your brain tune them out so you can focus on working, sleeping and all of your other daily activities.

You’ll use a remote to control the SCS when you’re feeling pain. You’ll be able to adjust to respond to different types and levels of pain.

Which conditions does a spinal cord stimulator treat?

Lots of health conditions and injuries can cause chronic pain. Your provider may recommend a spinal cord stimulator to manage:

• Angina or other types of chest pain
• Back pain
• Complex regional pain syndrome
• Diabetes-related neuropathy
• Neuropathic pain
• Persistent spinal pain syndrome after laminectomy surgery
• Phantom limb pain
• Postherpetic neuralgia (pain after having shingles)
• Spinal cord injuries

These are just some examples. Researchers are still studying how spinal cord stimulators can help people manage other types of pain. Your provider will tell you if an SCS is a good option for you.

How should I prepare for spinal cord stimulator surgery?

Your surgeon will tell you what you need to do to get ready for surgery. In general, you’ll need:

• A physical exam to make sure you’re healthy enough for surgery
• Blood tests
• Imaging tests, including a spine X-ray and/or an MRI

Tell your provider and surgeon which medications and over-the-counter supplements you take. You may have to stop taking some medications or supplements before surgery.

Getting a spinal cord stimulator is a two-step process. First, you’ll have a trial period. Your surgeon will put a temporary version of the SCS into your body. It’s a non-permanent option that lets you try spinal cord stimulation before they permanently insert one.

You’ll be able to get a sense for how the spinal cord stimulator works, and if it’s right for you. Your surgeon will probably suggest that you try the temporary SCS for a few weeks before deciding if you want the permanent version.

If the trial SCS manages the pain and you feel comfortable with using the device, your surgeon will implant the permanent spinal cord stimulator. A successful trial usually means the SCS reduces the pain you feel by at least half.

What happens during spinal cord stimulation surgery?

The steps for a spinal cord stimulator trial and the permanent implant are slightly different. For both surgeries, an anesthesiologist will give you anesthesia to numb your spine and back so you don’t feel pain during the surgeries. You might need general anesthesia that puts you to sleep.

Spinal cord stimulator trial surgery

Your surgeon will implant a temporary spinal cord stimulator into your back for your trial. Your surgeon will:

1. Make a cut (incision) in the skin on your back near where they’ll insert the SCS. This is usually in the middle of your back.
2. Insert tiny wires (leads) into the space between your spinal cord and your spinal bones (your vertebrae). This area is called the epidural space.
3. Connect the leads to a power source (generator) outside your body. They might stitch the generator to your skin or use a strong, temporary surgical glue.
4. Adjust the electrical current from the SCS to manage the kind of pain you’re feeling.

You’ll wear the external generator throughout the trial phase. When you feel pain, you can use the remote to control the current to the SCS. Your surgeon will show you how to control the stimulator.

Permanent spinal cord stimulator surgery

If you’re happy with how well the trial spinal cord stimulator manages pain, your surgeon will implant a permanent version a few weeks later.

The steps for a permanent SCS implant are similar to the trial. Your surgeon will:

1. Make an incision in your back in the same place as the trial.
2. Insert a small needle.
3. Insert the permanent leads. They’ll usually insert two leads, but there are some cases where you may only need one.
4. Advance leads to where they’ll implant the permanent generator. Instead of running the leads outside your body, they’ll thread them under your skin.
5. Implant the permanent generator, usually near the top of one of your butt cheeks (buttocks). You may be able to pick which side the generator is on. Tell your surgeon if you usually sleep on one side or the other. Unlike in the trial, this generator and the leads will be under your skin. There won’t be any part of the SCS outside your body. The generator is small (only a few inches long and around half an inch thick).
6. Turn on and program the SCS. They’ll make sure it’s working before they close the incisions.

What happens after spinal cord stimulator surgery?

The surgery for an SCS trial is usually outpatient. This means you can go home the same day.

Your surgery care team will tell you how to take care of the incisions after both surgeries. You’ll need to keep your surgery sites clean and change the bandages on them for around a week. They’ll also make sure you know how to use the SCS remote and adjust it before you go home.

You’ll have a follow-up appointment about two weeks after the permanent implantation surgery. A provider will remove the staples and/or stitches around the generator.

What are the benefits of spinal cord stimulator surgery?

A spinal cord stimulator is a safe, effective way to manage pain that other treatments haven’t.

An SCS can help you manage pain with less medication. It can help prevent side effects from pain medications, especially if you can’t take opioids. You may be able to reduce how much pain medication you take. You may end up not needing any at all.

The trial phase is also a benefit. There aren’t many surgeries that let you test drive them to see if they’ll work for you. You can try an SCS without having to commit to permanent surgery right away. If the trial doesn’t work as well as you’d hoped, you don’t have to get the permanent implant.

What are the most common complications of a spinal cord stimulator?

All surgeries have risks. Some complications that can happen from both kinds of SCS surgery include:

• Feeling tingling or numbness when using the SCS
• Infections
• Leads moving out of place, breaking or not working correctly
• Pain returning once your body adjusts to the SCS
• Spinal cord injuries from surgery or the leads breaking (this is rare)
• The generator failing or malfunctioning

Some people worry about their body rejecting the implanted leads or generator. These devices aren’t like an organ transplant that can experience rejection when your body’s immune system attacks it. Talk to your surgeon or healthcare provider if you’re feeling any new or changing pain around your implants.

What is the recovery time after spinal cord stimulator surgery?

You’ll need to take it easy and rest after both the trial and permanent implant surgeries. You’ll probably need to avoid some movement and motions, including:

• Bending
• Exercise or other intense physical activities
• Lifting heavy objects (your surgeon will give you a weight limit to avoid)
• Stretching

You won’t be able to get the leads or external generator wet during the trial phase. Avoid swimming, hot tubs and baths. You might need to keep yourself clean without getting in the shower. Your surgeon will tell you if it’s safe.

Your surgeon will also tell you when it’s safe to resume your usual routine. You’ll need four to six weeks after the permanent implant surgery to get used to the stimulator leads and their effects. This gives your body time to heal around the implanted generator and leads.

Spinal cord stimulator battery life

The batteries in a permanent SCS implant last a long time. Most will last for at least 10 years. Some models are rechargeable. If yours is, you’ll hold a charger near your skin to recharge the battery. Your surgeon will show you how to do this.

Spinal cord stimulator permanent restrictions

You should be able to resume many of your usual activities once your body heals around the implants. Many people can get back to activities that pain made them avoid in the past. But there are some things to keep in mind:

• It’s not safe to have an MRI with most SCS devices. Always remember to tell healthcare providers that you use a spinal cord stimulator before any imaging tests.
• You’ll set off security alarms in airports, concerts, arenas and anywhere else that requires you to go through a metal detector. These devices won’t interfere with how your SCS works, but you may need to explain that you use a medical device to security staff.
• Turn off the stimulator before driving, operating machinery or using power tools. It’s very rare, but if the SCS malfunctions while you’re doing any of these activities you may lose control of your body and hurt yourself or others.

What is the success rate of a spinal cord stimulator?

A spinal cord stimulator’s success rate can vary. It depends on which condition you’re using it to manage and how severe the pain is to begin with. Most people experience half as much pain.

Sometimes, spinal cord stimulators can lose effectiveness over time for unknown reasons. Talk to your surgeon. They’ll give you a better idea of what you can expect based on your unique circumstances.

When should I see my healthcare provider?

Your surgeon will schedule follow-up visits after the permanent implant surgery. They’ll help you adjust to the electrical stimulation from your SCS.

Go to the emergency room if you notice any severe side effects, including:

• A headache that’s constant when you stand or sit up, but goes away when you lie down. This can be a symptom of a cerebrospinal fluid (CSF) leak, which can happen during the needle or lead insertion. These headaches (called post-dural puncture headaches) typically get better on their own in a week or two.
• Signs of infection or sepsis around surgical sites. These include discoloration, swelling, pain and an oozing or bad-smelling discharge.
• Sudden numbness, tingling or muscle weakness. This can affect one or both sides of your body anywhere below the leads. These symptoms may mean the leads have shifted inside your spine, which can damage your spinal cord or nearby nerves. Some tingling is normal with certain types of stimulators. Ask your surgeon which sensations are normal or expected, and which are potential warning signs.