Spinal Cord Stimulator Implant

Who is a candidate for a spinal cord stimulator?

A spinal cord stimulator (SCS) is usually considered when chronic pain has lasted for months and has not improved enough with medicine, physical therapy, injections or surgery. It does not fix the cause of pain. It changes how pain signals reach your brain.

Our pain physicians most often consider SCS for people with:

• Failed back surgery syndrome – back or leg pain that continues after spine surgery.
• Complex regional pain syndrome (CRPS) – severe, burning pain, often in an arm or leg, after an injury.
• Chronic radicular pain – nerve pain that shoots down a leg or arm, such as long-lasting sciatica.
• Painful diabetic neuropathy – burning or tingling pain in the feet and legs from diabetes. The FDA has approved SCS systems for this use (PubMed review).

These match the conditions Cleveland Clinic lists for spinal cord stimulation.

Your doctor will also review your imaging, your past treatments and your general health. Some people are better served by another treatment first. If so, we will tell you.

The trial comes first

You do not commit to a permanent implant right away. First comes a trial.

• How it is placed: Your doctor uses x-ray guidance to place thin temporary wires (leads) near the spinal cord through a needle. The leads connect to a small battery you wear outside your body. The trial placement is usually outpatient, so you go home the same day (Cleveland Clinic).
• How long it lasts: Usually about a week. Medicare policy describes a typical trial of 1 to 2 weeks (CMS L35136).
• What you do: Go about your normal day and track your pain, sleep and activity. Keep the leads dry and avoid bending, twisting and heavy lifting.
• What counts as success: Medicare policy defines a successful trial as at least a 50% drop in your target pain, or a 50% drop in pain medicine, plus some improvement in how you function (CMS L35136).

If the trial does not help enough, the temporary leads are removed and no permanent device is placed.

The permanent implant

If your trial goes well, the permanent system is placed in a separate procedure. The leads go in through a small cut in your back. A small battery (generator) is placed under the skin, usually near the top of the buttock. Nothing stays outside your body (Cleveland Clinic).

Johns Hopkins notes the implant usually takes about two hours and patients can often go home the same day (Johns Hopkins Medicine). Your care team will tell you if you need an overnight stay.

Recovery basics

• Keep the incisions clean and change bandages for about a week.
• Avoid bending, stretching, heavy lifting and hard exercise until your surgeon clears you.
• Expect a follow-up visit about two weeks after the implant.
• Plan on four to six weeks for your body to heal around the leads and generator (Cleveland Clinic).

Living with a stimulator

• You are in control. A handheld remote or app lets you change settings or turn the device off.
• Charging. Some systems are rechargeable. You hold a charger over the skin near the generator for a short time. Others have a non-rechargeable battery that is replaced in a minor procedure when it runs low.
• MRI scans. Some stimulators are labeled “MR Conditional.” That means an MRI may be possible if specific safety conditions are met (FDA). Other devices are not safe for MRI. Always tell your imaging team you have a stimulator, and carry your device ID card.
• Travel and security. The device can set off metal detectors. Show your ID card to security staff.
• Driving. Turn the stimulator off before driving or using heavy machinery (Cleveland Clinic).

Weighing whether it is worth it? Read our honest look at spinal cord stimulator pros and cons.

Risks of a spinal cord stimulator

SCS is a surgical implant, so it carries risks. Cleveland Clinic and FDA device labeling list risks such as:

• Infection or bleeding at the incision
• Pain or soreness where the generator sits
• Leads moving out of place or breaking, which may need another procedure
• The generator or battery not working correctly
• Uncomfortable tingling or changes in stimulation
• A spinal fluid leak that can cause a headache
• Pain relief that fades over time
• Rarely, nerve or spinal cord injury

SCS does not work for everyone. That is why the trial matters so much.

Related options: DRG stimulation and peripheral nerve stimulation

Spinal cord stimulation is one type of neuromodulation. Depending on where your pain is, your doctor may also talk with you about:

• Dorsal root ganglion (DRG) stimulation – targets one specific nerve root area. It may suit pain focused in one spot, such as part of a leg or foot.
• Peripheral nerve stimulation (PNS) – places a small lead next to a single nerve outside the spine, for pain that comes from one nerve.

Spinal cord stimulator cost and insurance

Your cost depends on your plan’s deductible, copay and coinsurance. Many plans require prior authorization, records of the treatments you have tried, a psychological evaluation and a successful trial before they cover the permanent implant. Our team checks your benefits and requests authorization before your trial.

Where we offer spinal cord stimulator care

Consultations, trial planning and follow-up visits take place at our offices. Your care team will explain where your trial and implant procedures will be performed. Same-week appointments are available for new patients.

New York

Pain physicians: Dr. John Akhnoukh, Dr. Monika Misak, Dr. James Yu and Dr. Benjamin Souferi, DO.

New Jersey

Pain physicians: Dr. John Akhnoukh and Dr. Monika Misak.

Sources: Cleveland Clinic, Johns Hopkins Medicine, CMS LCD L35136, U.S. FDA, PubMed. This page is for general education and is not a substitute for medical advice.