Spinal Cord Stimulation (SCS) Therapy
The Permanent Implant Procedure
After a Successful Trial
If the trial confirms that SCS is effective for you, the permanent implant procedure is scheduled.
With a surgical trial, the leads placed during the trial remain in place, and the pulse generator (battery) is added. With a percutaneous trial, the trial leads are removed, and entirely new leads and a pulse generator are implanted.
| Step | What Happens |
|---|---|
| 1 | Anesthesia is administered in the operating room |
| 2 | Permanent leads are placed through the back (with a surgical trial, the existing leads are kept) |
| 3 | The pulse generator is implanted under the skin of the abdomen or buttock |
| 4 | The leads are connected to the generator |
| 5 | The system is tested |
| 6 | Surgery is complete (approximately 1–2 hours) |
Anesthesia Options
Several anesthesia approaches may be used for SCS surgery:
| Anesthesia Method | Features |
|---|---|
| Local anesthesia | You remain awake, which allows real-time confirmation of stimulation placement |
| Local anesthesia with sedation | A mild sedative helps you relax while remaining lightly conscious |
| General anesthesia | You are fully asleep during the procedure |
The choice of anesthesia depends on the facility and physician's approach. If you have concerns about anesthesia, please discuss them with your doctor.
Hospital Stay
- Trial: Approximately 1 week (varies by trial method)
- Permanent implant: Approximately 5–7 days (varies by facility)
Surgical Risks
Every surgical procedure carries some risk. A large-scale study (Cameron 2004, 2,700 cases) reported the following complications:
| Risk | Frequency | Description |
|---|---|---|
| Lead migration | 13.2% | Lead shifts position --> Revision surgery to adjust |
| Lead fracture | 9.1% | Loss of stimulation --> Lead replacement |
| Infection | 3.4% | Antibiotic treatment; device removal may be necessary |
| Uncomfortable stimulation | 2.4% | Managed by adjusting settings |
| Premature battery depletion | 1.6% | Generator replacement (minor procedure) |
| Hardware malfunction | 1.3% | Device replacement |
| Spinal fluid leak | 0.3% | Usually resolves with rest |
Note: These figures are from a 2004 study. Today's devices and surgical techniques have improved significantly, and complication rates have decreased.
Over the long term, the following may also occur:
| Risk | How It's Managed |
|---|---|
| Decreased effectiveness over time | Stimulation settings are adjusted, or stimulation modes are changed |
| Battery life | Rechargeable units last 10+ years; non-rechargeable units last several years before the generator is replaced (a minor procedure) |
Every effort is made to prevent these complications, but no surgery is 100% risk-free. The decision should weigh the risks of the procedure against the potential benefit of meaningful pain relief.
Post-Operative Rest
To prevent the leads from shifting, you will be asked to limit significant bending or twisting of the back after surgery. The duration of restricted activity varies by facility but is typically several days to one week.