Spinal Cord Stimulation

Spinal cord stimulators are medical device implants. They manage chronic pain by sending low-level electrical stimulation to spinal cord nerves. This stimulation disrupts pain signals as they travel between the spinal cord and the brain.

These specialized devices can help with pain relief even when other treatment options have failed.


What is a spinal cord stimulator?

Spinal cord stimulators are medical devices that a doctor can implant in your body to manage chronic pain. These systems include a small generator device, like a pacemaker, and wires called leads.

This device delivers mild electrical stimulation through the leads to nerves along the spinal column. The spinal cord stimulation modifies or blocks nerve activity to minimize the sensation of pain reaching the brain.

A spinal cord stimulator implant lets a patient directly control its stimulation activity by using a small external remote.

Illustration of a spinal cord stimulator implanted in an individual's back.
Spinal cord stimulators modify or block nerve activity to minimize the sensation of pain reaching the brain.

How long have spinal cord stimulators been in use?

The first commercial spinal cord stimulator (SCS) device dates back to 1968. By 1981, the first fully implantable system became available.

Since then, spinal cord stimulators have gone through many generations of advancements and improvements. Eligible patients can now access a broad range of SCS devices and customization options.

What kind of pain does spinal cord stimulation target?

Spinal cord stimulation targets chronic, severe pain that other medical options cannot manage.

Acute pain is normally a protective process. It is our body’s warning about injuries, illnesses, or diseases. It normally lasts for a short period.

Chronic pain is different from acute pain. Those suffering from it find it overwhelming and that it does not let up or go away. And it can significantly impact our ability to function.

Over time, chronic pain can rewire our brain and nervous system. Those changes can increase our sensitivity to feeling pain beyond normal thresholds, a condition called hyperalgesia. And it can create pain in circumstances that normally aren’t painful, a condition called allodynia.

Spinal cord stimulation is an option to manage chronic pain for those suffering from these conditions.

How does a spinal cord stimulator work?

A spinal cord stimulator system includes a small, implanted pulse generator called a neurostimulator. It also has a set of small wires called leads.

A patient’s doctor places the leads at specific nerves behind the spinal cord. They will have identified these nerves as the potential carriers of problem chronic pain signals to the patient’s brain.

The neurostimulator, when activated, delivers small pulses of mild electric current through the leads to the specific nerves. These impulses mask pain signals traveling to the brain.

A patient can control their spinal cord stimulator with a remote. The remote can turn the spinal cord stimulator on or off and increase or decrease the stimulation level. It can also activate different custom programs for a specific patient to handle pain.

The spinal cord stimulator does not eliminate what is causing a patient’s pain. But it does change the way that the brain perceives the pain.

What does spinal cord stimulation feel like?

Different spinal cord stimulator devices and configurations will handle pain slightly differently. Some may use a light tingling, called paresthesia, or a fluttering sensation to replace the pain. Other spinal cord stimulation therapies don’t cause any sensation at all.

The level of pain relief experienced will vary across different patients. However, the goal is to decrease pain by 50 to 70 percent.

What are the different types of spinal cord stimulators?

Six established companies compete in the global spinal cord stimulator medical device market. Many of them offer multiple versions and models of spinal cord stimulators.

Patients should talk to their doctor about which spinal cord stimulator is best for them.

Neurostimulation Medical Devices

There are two additional classes of neurostimulation systems that operate similarly to spinal cord stimulation. They are dorsal root ganglion (DRG) stimulation and peripheral nerve stimulation (PNS).

Procedure Details

What are the two stages of the spinal cord stimulator implant procedure?

There are two stages involved in the spinal cord stimulator procedure.

The first is a trial stage, which is temporary. It helps confirm a patient’s experience in how well a spinal cord stimulator may relieve their pain during different activities.

The second is a surgical implant procedure. A decision to proceed will depend on the patient and their doctor’s assessment of the trial’s effectiveness.

How is a spinal cord stimulator trial procedure performed?

A trial for a spinal cord stimulator typically takes about 30 to 90 minutes to complete. It usually takes place at an outpatient surgery center.

  1. Temporary Leads Placed. Using a small insertion device, a doctor will place temporary leads near a patient’s spine. The doctor will use a local anesthetic. The leads are small, flexible wires.
  2. Optimal Lead Locations Identified. The doctor will then apply test stimulation. They will ask the patient how they feel to determine the best lead locations.
  3. External Spinal Cord Stimulator Connected. The doctor will then connect the leads to a temporary external spinal cord stimulator. This device will provide stimulation therapy during the trial.
  4. Trial Spinal Cord Stimulator Programmed. The medical team will then program the trial stimulation device. They will customize it specifically for the patient.

How long does a spinal cord stimulator trial last?

A spinal cord stimulator trial period can last up to 10 days.

  • A patient’s doctor will instruct them to try activities that have been difficult because of their pain.
  • The doctor will provide instructions on limits for physical activity to prevent the trial leads from dislodging.
  • Most trial systems are not waterproof. The patient must protect the external trial neurostimulator from water during showering or bathing.
  • The benefits of a screening trial may be immediate, or they may take a few days.

After the trial period, a medical professional can remove the trial stimulator leads in a simple office procedure.

How is the permanent spinal cord stimulator surgery performed?

Following a successful trial, a patient and their doctor will decide if a permanent implant is a good option.

The permanent implant procedure is similar to a trial procedure. A doctor will place leads near the patient’s spinal cord during the surgery. They will permanently implant a spinal cord stimulator under the skin in the buttocks area.

The doctor will use one of two types of leads: percutaneous or paddle. Percutaneous leads are smaller than paddle leads. The doctor inserts these leads along the spine using an epidural needle.

Paddle leads are larger. The doctor typically secures them to the spinal column beneath a small bone.

The procedure usually takes place at an outpatient surgery center. It typically takes one to three hours to complete.

Risks / Benefits

What are the risks associated with a spinal cord stimulator?

All surgeries have risks, even minimally invasive surgeries.

During the trial procedure, complications can occur, including bleeding into the epidural space, infection, and other side effects. You should not undergo a trial if you have an active infection on the day of the procedure.

Risks for permanent spinal cord stimulator surgery include:

  • Infection.
  • Lead movement away from initial placement.
  • Implant site pain or discomfort.
  • Failure in the therapy’s effectiveness.

Patients considering spinal cord stimulator implants should discuss all risks with their doctor. Not everyone responds to spinal cord stimulators similarly, and individual experiences may vary.

What are the benefits of a spinal cord stimulator?

Spinal cord stimulation can help a patient manage many different types of chronic pain that have not responded to other treatments. It can improve the ability to participate in usual daily activities.

Spinal cord stimulators are a non-opioid, FDA-approved pain management alternative. It can reduce a patient’s dependence on pain medications. It can serve as an effective alternative to major spine surgery.

Recovery and Outlook

What happens immediately after this procedure?

After the permanent implementation surgery, it may take several weeks to recover. During that time, your doctor will advise you to avoid certain activities. These may include movements that involve lifting, bending, and twisting. Each type of spinal cord stimulator will have its guidelines that you should discuss with your doctor.

Your medical team will turn on the system and configure it after recovery. Patients will then work with their doctor to properly adjust and personalize the spinal cord stimulator.

A patient’s doctor will also guide you on safely using your stimulator in your daily life.

A patient will use an external remote control for their spinal cord stimulator. The remote will turn on or off stimulation, increase or decrease intensity levels, and target different body areas.

When should you call your doctor after the procedure?

In general, you should contact your doctor if:

  • You have pain around the implant that lasts longer than two weeks.
  • You notice significant redness around their wound areas. In this case, your doctor must check for infection or, in rare cases, a reaction to the implant.
  • You plan to make major lifestyle changes due to having better control over your pain.
  • You notice that your spinal cord stimulator stops working. In this case, you should turn the device off before contacting your doctor.

Can you drive or operate heavy machinery with a spinal cord stimulator?

It’s important not to operate automobiles, motorized vehicles, or any heavy machinery with a neurostimulator turned on. It would be best if you switched it off in these situations.

Sudden stimulation activity can distract you from the safe operation of the vehicle or equipment.

Can you pass through theft detectors or security screening devices with a spinal cord stimulator?

Theft detectors and security devices are commonplace in airports, libraries, and stores. You should always follow your doctor’s and the manufacturer’s instructions related to your specific stimulator about passing through screening devices. While following those instructions as a priority, the following is general guidance:

  1. You should request a manual search, if possible. Your doctor or device manufacturer will issue you a patient identification card for your spinal cord stimulator. Show that card to security personnel and ask for a manual search.
    They may use a manual security wand. It would be best if you asked them not to hold the wand near the location of your device longer than necessary.
  2. If you must pass through a screening device, stay as far away from security gates as possible. You should turn off your spinal cord stimulator before passing through any security gates. It would be best not to linger for an extended period near the gates. After passing through, you can turn your device back on.

More information is available from the TSA website about passing through security with medical devices.

Can you use advanced diagnostic imaging with a spinal cord stimulator?

If powered off, you can normally get X-rays or a CT scan with a spinal cord stimulator. Before undergoing an imaging scan, it is important to inform your doctor, nurse, or technician about your neurostimulator.

You must take adequate precautions and be careful with magnetic resonance imaging (MRI) scans. Some models of spinal cord stimulators are not compatible with MRIs. If your device is not compatible, receiving an MRI could lead to a serious injury.

Some models of spinal cord stimulators are compatible with MRI use with pre-approval from your doctor and manufacturer. Some spinal cord stimulator models allow scanning on any part of your body, while others restrict scanning to only the head.

  1. If your spinal cord stimulator is MRI-compatible, you still need to take precautions:
  2. Tell the doctor who prescribed an MRI scan that you have an implanted spinal cord stimulator.
  3. Contact the pain specialist who implanted your spinal cord stimulator for guidance.

When scheduling your MRI, provide the office staff with your spinal cord stimulator’s manufacturer and model number. Also, provide them with contact information for your pain specialist.

Can a spinal cord stimulator be removed?

A doctor can safely remove a spinal cord stimulator system through surgery. The most common reason for removal is inadequate pain relief. This decision may come after years of living with the device.

Some issues may occur over time, requiring additional surgical procedures to correct. The leads may shift from their original positioning. This can reduce the effectiveness of the device in controlling pain.

A lead or the implanted neurostimulator may break. This could be the result of a fall or other trauma. Or in rare cases, there could be a malfunction with the device.

You should discuss your options with your pain specialist to address these situations.

When To Consider It

Who is a good candidate for a spinal cord stimulator?

Suitable candidates for spinal cord stimulation have tried conservative treatments without adequate improvement. They also have one of the following conditions:

  • General back pain determined to be treatable with SCS by a patient’s pain management doctor.
  • Complex Regional Pain Syndrome (CRPS), including the form of CRPS known as reflex sympathetic dystrophy (RSD).
  • Failed back surgery (FBS) syndrome, where back pain has continued after laminectomy surgery. Post-laminectomy syndrome or persistent spinal pain syndrome (PSPS) are alternate names for this syndrome.
  • Neuropathic pain that occurs because of malfunctions in a patient’s nerves.
  • Diabetes-related neuropathy (nerve damage).
  • Phantom limb pain (PLP) occurring after amputation.

Researchers are also evaluating additional conditions that may benefit from spinal cord stimulation.

Any patient considered a good candidate for spinal cord stimulation therapy must undergo a thorough screening process before undergoing the procedure.

Video Overview: Spinal Cord Stimulator Implant