SCS Therapy: The Complete Guide
Part 0: Which Type Are You?
There are 3 groups of patients for whom SCS may be appropriate. Understanding which group you fall into will help you have a more productive conversation with your doctor.
Type 1: No Clear Surgical Target
| Feature | Explanation |
|---|---|
| Situation | You have not yet had spinal surgery |
| Pain characteristics | Mainly neuropathic pain (numbness, radiating pain) |
| Imaging findings | Imaging does not match your symptoms, or there are degenerative changes at multiple levels |
| Surgical assessment | You have been told "there is no clear surgical target" or "it is unclear whether surgery can help" |
| Role of SCS | A valid treatment option instead of surgery (not a compromise) |
| Timing | Best results within 6 months to 2 years after starting conservative treatment (before the pain becomes deeply chronic) |
Type 2: Surgery Is Possible, but the Burden or Risk Is Too Great
| Feature | Explanation |
|---|---|
| Situation | There is a treatable condition, but it requires fusion at 2 or more levels |
| Patient factors | Advanced age or existing health conditions that increase surgical risk |
| Role of SCS | An alternative to surgery, or considered alongside surgery |
| Key point | The more levels that need fusion, the greater the potential advantage of SCS |
Type 3: Pain Persists After Surgery
| Feature | Explanation |
|---|---|
| Situation | You have already had spinal surgery |
| Pain characteristics | Neuropathic pain continues after surgery |
| Imaging findings | Structurally improved on imaging, yet pain persists |
| Medical term | Post-surgical spinal pain syndrome (also called failed back surgery syndrome, or FBSS) |
| Role of SCS | An effective treatment for post-surgical pain (success rate 60-80%) |
| Timing | If pain continues 3 to 6 months after surgery |
Not Sure Which Type You Are?
Use these questions to help you find out:
"Have you had spinal surgery before?"
- Yes -- You may be Type 3 (pain persists after surgery)
- No -- You may be Type 1 or Type 2 (continue to the next question)
(If you have not had surgery) "Has your doctor told you that surgery is difficult, or that there is no clear surgical target?"
- Yes -- This is typical of Type 1
- No -- Continue to the next question
(If you have not had surgery) "Have you been told that fusion at 2 or more levels is needed?"
- Yes -- You may be Type 2
- No -- First, confirm whether surgery is an appropriate option for you
An important perspective:
All three types are legitimate candidates for SCS. For Type 1 patients, SCS is not "a fallback because surgery is not possible" -- it is "an effective treatment for neuropathic pain that surgery cannot address." For Type 2 patients, it is important to weigh the risks of multi-level fusion (adjacent segment disease, infection, prolonged hospitalization, etc.) against the benefits of SCS.
About considering SCS before surgery -- the supervising physician's perspective:
Considering SCS as a primary treatment option before undergoing surgery (for Type 1 and Type 2 patients) is a treatment approach based on the supervising physician's clinical experience and the latest medical evidence. For Type 2 patients who require multi-level fusion, the risk of post-surgical complications increases with the number of levels fused, which means SCS offers a relatively greater advantage. This approach is gradually gaining recognition in Japan through the supervising physician's lectures and presentations, but it is not yet a standard treatment approach agreed upon by all medical institutions and physicians.
Treatment approaches may vary between medical institutions and individual doctors. We recommend using the information on this page as a reference and discussing your options thoroughly with your own doctor.