What Is Spinal Cord Stimulation?

Spinal cord stimulation uses a small electronic device—similar to a pacemaker—that sends mild electrical signals to nerves near your spinal cord. These signals change how pain information is processed by your nervous system, which may reduce the sensation you feel of pain in certain areas of your body.

An SCS system has three components:

1. Thin wires (leads) that are inserted near your spinal cord
2. A small battery and computer (pulse generator), which is implanted under your skin
3. A handheld controller that lets you adjust settings within the range set by your spine doctor

Newer systems may allow different patterns of stimulation, such as high-frequency pulse or burst/blast modes.

Who Might Be a Candidate for SCS?

SCS is not a first-line treatment choice. However, you may be considered for treatment if you have chronic back and/or leg pain for many months or years. You may qualify for SCS when conservative treatments, including physical therapy, medications, and injections, do not give enough relief. Another reason is when surgery has already been done, and your pain persists (sometimes called “failed back surgery syndrome”), or back surgery is not a good option.

Before recommending SCS, your care team will usually review your medical history, imaging, and previous treatments in all possible detail. It is vital that you do not have any ongoing, untreated problem that clearly needs another type of surgery.

The Trial Phase

One advantage of SCS is that there is usually a trial period before a permanent device is implanted. During the trial, leads are placed through a needle into the space near your spinal cord, usually with local anesthesia and while you are under mild sedation. Then, the leads are connected to an external battery outside your body. You go home with the system in place for several days to a week, depending on your clinic’s protocol. You track how much relief you get, how your function changes, and how you feel overall.

If the trial provides meaningful pain relief and improved function, often defined as at least around 50% reduction in pain, your care team may suggest moving ahead with a permanent implant. I

If the trial does not work out, the leads are removed, and you may be offered other options.

The Permanent Implant Procedure

If you and your clinicians decide to proceed after a successful trial, a small incision is made to place the battery under the skin, often near your buttock or in your abdomen. Leads are positioned near the spinal cord and connected to the battery. The system is programmed, and you are given instructions on how to use the handheld controller.

The procedure is usually done with anesthesia. Most people go home the same day or after an overnight stay.

Benefits and Limitations

Here is a comparison of the potential benefits with some of the downsides caused by the limitations.

Benefits of SCS may include:

• You get reduced pain in the lower back, legs, or both for certain patients.
• You have an improved ability to function in daily life.
• In some cases, you may reduce your need for meds.

However, SCS has limitations and is not right for everyone:

• It does not cure the underlying cause of pain.
• Not all patients get enough relief, even after a positive trial.
• The device can have problems, such as lead movement, battery issues, or infection, which may require additional procedures.
• You will need ongoing follow-up for programming and device checks.

Risks and Possible Complications

Here are some more things to worry about.

Risks of SCS can include infection at the implant site, bleeding or fluid collection, lead movement, which may change how well the device works, and rare, but serious, complications near the spinal cord. Your care team will review these risks in detail with you and explain how they plan to manage them.

Questions to Ask Your Specialist

If SCS is being discussed with your healthcare provider, consider asking:

• Why do you think I might be a good candidate?
• What other options are available at this stage?
• How will you measure whether the trial is successful?
• What kind of pain relief do most people in my situation realistically experience?
• How often will I need follow-up visits, and what happens if the device stops working well?

You may also want to ask how SCS could affect other aspects of your life, such as going through airport security, getting MRI scans, or doing specific activities.

Putting SCS in Perspective

Spinal cord stimulation can be life-changing for some people with severe, long-standing back and leg pain, but it is a major step that requires careful consideration. It is usually only warranted after all other options have been tried and failed. You only want to try this when there is a realistic chance that nerve-targeted treatment will help you. By understanding how SCS works and what to expect, you can consider the possibility in comparison with other choices for your chronic pain relief.