Spinal Cord Stimulator Implantation
Guide to Spinal Cord Stimulator Implantation
Spinal Cord Stimulator (SCS) implantation is a minimally invasive procedure that places electrodes near the spinal cord to modulate pain signals and alleviate chronic pain.

What is Spinal Cord Stimulator Implantation?
Spinal Cord Stimulator (SCS) implantation is a pain-management procedure that places thin electrodes in the epidural space near the spinal cord. These electrodes connect to a pulse generator implanted under the skin, usually in the buttock or abdomen. By emitting precise electrical pulses, the system modulates pain pathways and can significantly decrease the perception of chronic pain without the side effects of systemic medications.
Why is the Procedure Performed?
SCS is recommended to control chronic, refractory pain conditions such as:
- Failed back or neck surgery syndrome.
- Complex regional pain syndrome (CRPS) types I & II.
- Peripheral neuropathies.
- Chronic radiculopathy or sciatica not amenable to further surgery.
- Pain from spinal stenosis or degenerative disc disease.
Goals include reducing pain intensity, improving function, decreasing opioid use, and enhancing quality of life.
How is the Procedure Performed?
The process occurs in two stages—trial and permanent implantation—both performed under fluoroscopic or CT guidance with local anesthesia and conscious sedation.
- Trial Phase:
- Lead Placement: Through a small epidural needle, trial leads are advanced to the appropriate spinal level.
- Programming: Stimulation settings are customized while you are awake to target painful regions.
- Assessment: Leads are secured externally to a temporary battery worn on a belt for 5–7 days. If pain relief ≥50% is achieved, you may proceed to permanent implantation.
- Permanent Implantation:
- Lead Anchoring: Leads are inserted via a small incision and anchored to prevent migration.
- Generator Pocket: A pulse generator (battery) is implanted subcutaneously in the gluteal or abdominal region.
- Connection & Testing: Leads connect to the generator; intraoperative testing ensures coverage.
- Closure: Incisions are closed with absorbable sutures or staples and dressed sterilely.
The permanent procedure typically lasts 1–2 hours and may be outpatient or involve an overnight stay.
What are the Risks and Benefits of the Procedure?
- Benefits:
- Significant reduction in chronic pain and paresthesia coverage.
- Decreased need for opioid or other pain medications.
- Adjustable, reversible therapy—settings can be reprogrammed to optimize relief.
- Improved sleep, function, and quality of life.
- Risks:
- Lead migration or breakage requiring revision.
- Infection at the incision or around hardware.
- Hematoma or bleeding in the epidural space.
- Dural puncture causing spinal headache.
- Hardware malfunction or battery depletion.
- Allergic reaction to device materials (rare).
Your physician will review individual risk factors and mitigation strategies.
Preparing for Spinal Cord Stimulator Implantation
What to Expect During the Procedure
You will be positioned prone on an x-ray table. Local anesthetic numbs the surgical site, and IV sedation keeps you comfortable but able to respond during stimulation testing.
Pre-op Instructions
- Fasting: Do not eat or drink for 6–8 hours before the procedure.
- Medication Review: Inform your doctor of all prescriptions, especially blood thinners and diabetes medications; adjustments may be necessary.
- Imaging: Recent MRI or CT helps guide electrode placement and rule out spinal anatomy concerns.
- Psychological Evaluation: Many insurers require a screening to ensure appropriate expectations and coping strategies.
- Transportation: Arrange for a responsible adult to drive you home.
Medications to Avoid Before the Procedure
- Blood Thinners: Anticoagulants (warfarin, apixaban) and antiplatelet agents (clopidogrel, aspirin) may need to be paused under physician guidance.
- NSAIDs: Often held prior to surgery to reduce bleeding risk.
- Herbal Supplements: Stop garlic, ginkgo, ginseng, and similar supplements that affect clotting.
- Diabetes Medications: Adjust as instructed due to fasting and sedation.
What to Bring to the Surgery Center
- Medication List with dosages.
- Photo ID and Insurance Card.
- Loose, Comfortable Clothing easy to wear over the generator site.
What to Expect After the Procedure
- Immediate Recovery: Vital signs are monitored; incisions are checked. You will receive programming instructions for your device.
- Activity: Walking is encouraged, but avoid bending, twisting, or lifting >10 lbs for 6 weeks to prevent lead migration.
- Diet: Resume light meals as tolerated.
Post-op Instructions
- Incision Care: Keep dressings clean and dry. Avoid submersion in water until cleared.
- Device Use: A programmer remote lets you adjust stimulation. Follow training from the representative.
- Follow-up: Initial device check occurs 7–14 days post-op with suture removal if needed, followed by programming sessions.
Recovery Tips
- Gradual Return: Increase activity slowly; adhere to lifting restrictions.
- Log Pain Relief: Track pain scores and medication use to help fine-tune settings.
- Physical Therapy: May be recommended to improve strength and posture.
When to Seek Medical Attention
- Emergency Symptoms: Severe back pain, sudden leg weakness, loss of bowel or bladder control, high fever (>101°F), redness or drainage from incisions.
- Device Issues: If stimulation stops, becomes painful, or you suspect lead migration, contact your physician immediately.
By understanding each step of Spinal Cord Stimulator implantation, you can help ensure a smooth procedure and successful long-term pain relief. Always follow your healthcare provider's instructions and communicate any concerns promptly.
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