Treatment Decision Guide

1. Steps 1 and 2: Your Symptoms and Treatment History

Step 1: Assess Your Current Symptoms

Your answers to the questions below can show which treatment direction may suit you.

This is not a diagnosis. Use it as preparation for your conversation with your doctor.

Walking Ability

How far can you walk continuously?

Your answer: _______________

Pain Level

On a scale of 0 to 10, how would you rate your current pain? (0 = no pain, 10 = worst possible pain)

Your score: _____ /10

Neurological Symptoms

Check any that apply to you:

• Numbness in the legs
• Reduced sensation in the legs
• Weakness in the legs
• Tendency to stumble or trip
• Difficulty urinating or urinary leakage
• Difficulty controlling bowel movements

If you have urinary or bowel symptoms, contact your doctor immediately.

Impact on Daily Life

Check any that apply to you:

• Unable to do housework
• Unable to go shopping
• Interferes with work
• Unable to enjoy hobbies
• Avoiding going out
• Unable to sleep at night

Number of items checked: _____ items

Step 2: Review Your Treatment History

Treatments You Have Already Tried

Check any that apply to you:

Medication

• Took pain relievers (e.g., loxoprofen/Loxonin)
• Took nerve pain medication (e.g., pregabalin/Lyrica, mirogabalin/Tarlige)
• Took blood flow medication (e.g., limaprost/Opalmon)
• Continued for a sufficient period (3 months or more)

Rehabilitation

• Received physical therapy from a physical therapist
• Continuing exercises at home
• Continued for a sufficient period (3 months or more)

Injections

• Received nerve block injections
• Received multiple injections (___ times)
• Was effective / Was not effective (circle one)

Surgery

• Had spinal surgery before
• Surgery was _____ years ago
• Symptoms after surgery: Improved / Unchanged / Worsened (circle one)

2. Steps 3 and 4: Your Situation and Treatment Direction

Step 3: Organize Your Situation

Symptom Assessment

Use your answers above to sum up your situation.

Walking ability: Mild / Moderate / Severe (circle one)

Pain level: Mild / Moderate / Severe (circle one)

Neurological symptoms: None / Mild / Moderate or more (circle one)

Impact on daily life: Small / Moderate / Large (circle one)

Treatment History Assessment

Conservative treatment: Tried sufficiently / Still have options to try (circle one)

Surgical history: None / Yes (Improved / Did not improve) (circle one)

Step 4: Treatment Direction

Pattern A: Continue Conservative Treatment

This may apply if:

• Your symptoms are mild to moderate
• The impact on your daily life is small to moderate
• You have not yet tried conservative treatment sufficiently
• You have no neurological symptoms, or they are mild

Recommended direction:

• Adjust medications
• Continue or intensify rehabilitation
• Consider nerve block injections
• Reassess after 3 to 6 months

Pattern B: Consider Surgery

This may apply if:

• Conservative treatment has been tried sufficiently without improvement
• Your symptoms are moderate to severe
• The impact on your daily life is significant
• You have neurological symptoms
• You have not had surgery before
• Imaging clearly shows where the nerves are compressed, and there is a structural problem

Recommended direction:

• See a spine surgeon
• Evaluate whether surgery is appropriate
• Discuss the type of surgery (decompression or fusion)
• A second opinion is also an option

Key consideration: Along with "Is the pain neuropathic, and can surgery clearly fix it?", the scale and risk of the surgery matter too. If the compression site is clear and can be addressed with decompression at 1-2 levels, surgery is often effective. If imaging and symptoms do not match, or there is degeneration at multiple levels, SCS should be considered. If there is compression but multi-level fusion is needed, the surgical burden is large, so SCS should also be considered. If you are older or have health conditions that make surgical risk high, SCS is less invasive and should be considered first.

Pattern B-2: Consider SCS (Surgery Is Possible but Would Be Major)

This may apply if:

• Conservative treatment has been tried sufficiently without improvement
• Imaging shows compression, but fusion at 3 or more levels would be needed
• You are older, or health conditions make surgical risk high
• You prefer a reversible (undoable) treatment
• The more levels that need fusion, the greater the surgical burden and recovery time

Recommended direction:

• Consult an SCS specialist and compare both surgery and SCS
• Confirm that SCS may offer greater advantages when more levels need fusion
• Discuss how implantation would proceed (implant at once, or do a trial first)
• A second opinion is also an option

Why consider SCS when multi-level fusion is needed: The more levels are fused, the longer the surgery, the greater the blood loss, and the higher the risk of complications. Fusing a large section of the spine can also put extra strain on nearby levels later (adjacent segment disease). SCS is less invasive and can be removed if it does not work, so it is a worthwhile option to try before committing to major surgery.

Pattern C-1: Consider SCS (Before Surgery)

This may apply if:

• Conservative treatment has been tried sufficiently without improvement
• Imaging does not match your symptoms
• There is degeneration at multiple levels
• Neuropathic pain is the main problem
• Surgery is difficult (due to age, health conditions, or high surgical risk)
• You have not yet had surgery

Recommended direction:

• See a pain clinic doctor or SCS specialist
• Evaluate your SCS candidacy
• Discuss how implantation would proceed (implant at once, or do a trial first)

What makes this pattern different: SCS is more than "a treatment for people who cannot have surgery." It is an effective treatment option for neuropathic pain where structural problems are not clearly identified. When surgery cannot clearly address the problem, considering SCS early can help keep the pain from becoming deeply chronic.

The supervising physician's perspective: The approach of considering SCS before surgery (Pattern C-1) is based on the supervising physician's clinical experience and evidence. Opinions may differ between medical institutions, so discuss this with your own doctor.

Pattern C-2: Consider SCS (After Surgery)

This may apply if:

• You had surgery but pain remains
• Reoperation carries high risk
• Chronic pain is the main problem
• Imaging shows the problem has improved, yet pain continues

Recommended direction:

• See a pain clinic doctor or SCS specialist
• Evaluate your SCS candidacy
• Discuss how implantation would proceed (implant at once, or do a trial first)

Pattern D: Urgent Medical Attention Needed

This applies if:

• You have urinary or bowel problems
• Leg strength has suddenly weakened
• Symptoms are deteriorating rapidly

Recommended direction:

• See a doctor immediately
• Emergency surgery may be necessary

3. Step 5 and Common Situations

Step 5: Preparing for Your Doctor's Appointment

Your Situation Summary Sheet

Print this sheet and bring it to your appointment.

[!tip] Treatment Consultation Sheet Current Symptoms

• Continuous walking distance: ___________ m
• Pain score: _____ /10
• Main symptom location: _________________
• Neurological symptoms: ☐ Numbness ☐ Reduced sensation ☐ Weakness

Impact on Daily Life

• Things I can no longer do: ______________
• What troubles me most: __________________

Treatment History

• Medications: ____________________________
• Rehab: ☐ Yes (___ months) ☐ No
• Injections: ☐ Yes (___ times, effect: ___) ☐ No
• Surgery: ☐ Yes (___ years ago) ☐ No

Your Hopes and Questions

• ---

• ---

Advice for Common Situations

Situation 1: You Have Not Yet Been Diagnosed

Your situation: You have back or leg pain but have not yet seen a doctor

Advice:

1. Start by visiting an orthopedic surgeon
2. Get an MRI to check for stenosis
3. Consider treatment options once a diagnosis is made

Situation 2: You Are Currently Receiving Conservative Treatment

Your situation: You are taking medications or doing rehabilitation, but improvement has been limited

Advice:

1. Has the treatment period been long enough? (Continue for at least 3 months)
2. Are the types and doses of medication appropriate?
3. Have you tried nerve block injections?
4. If no improvement after 3 to 6 months, consider surgery

Situation 3: You Have Been Advised to Have Surgery

Your situation: Your doctor has recommended surgery, but you are unsure

Advice:

1. Confirm whether the situation is urgent (bladder problems, etc.)
2. Understand the type of surgery and its risks
3. Ask: "Do the imaging findings match my symptoms? Is the compression site clear?"
4. Ask: "How many levels would need to be fused?" The more levels fused, the greater the surgical burden
5. If multi-level fusion is needed, ask about SCS as an alternative
6. A second opinion is an option
7. Also confirm the risks of not having surgery

Thinking it through step by step: When surgery is recommended, three questions can help. First: "Is the compression site clear?" If it is clear and can be addressed with decompression at 1-2 levels, surgery is often effective. Second: "Is multi-level fusion needed?" If 3 or more levels need fusion, SCS is worth considering alongside surgery. Third: "Is the surgical risk high?" If you are older or have health conditions, trying the less invasive SCS first may be reasonable.

Situation 4: You Have Been Told Surgery Is Difficult, or Major Surgery Would Be Needed

Your situation: One or more of the following applies:

• You have been told "there is no clear surgical target" or "there is degeneration at multiple levels"
• Surgery is possible, but fusion at 3 or more levels would be needed
• You are older or have health conditions that make major surgery risky

Advice:

1. "Surgery is difficult" or "surgery would be major" does not mean "there is no treatment"
2. SCS is a valid treatment option before surgery, both for those who cannot have surgery and for those who want to avoid major surgery
3. It is an effective treatment when imaging does not match symptoms or when multi-level degeneration is present
4. When multi-level fusion is needed, SCS may offer greater advantages as the number of levels increases
5. SCS is relatively less invasive, and the device can be removed if it is not effective
6. Consult a pain clinic doctor or SCS specialist
7. Implantation is usually done in one operation; a trial is available if you wish

An important perspective: SCS is more than "a compromise for people who cannot have surgery." It is an effective treatment option for neuropathic pain. When multi-level fusion is needed in particular, the burden of surgery (longer operating time, blood loss, risk of adjacent segment disease) must be weighed against SCS. The decision to try SCS first is a rational one. The ideal timing is 6 months to 2 years after conservative treatment, before the pain becomes deeply chronic.

Situation 5: Pain Persists After Surgery

Your situation: You had surgery, but pain remains

Advice:

1. How much time has passed since surgery? (Recovery can take time)
2. Get updated imaging to assess the current situation
3. Evaluate whether reoperation is possible
4. SCS is an effective treatment for post-surgical pain
5. Post-surgical spinal pain syndrome is one of the best indications for SCS (ask your doctor what improvement you can realistically expect)

About post-surgical pain: Even when surgery resolves structural problems, neuropathic pain may remain. This is called "post-surgical spinal pain syndrome" and is an excellent indication for SCS.

Situation 6: You Are Elderly and Worried About Surgery

Your situation: You are in your 80s and surgery has been recommended, but you are worried about your physical stamina

Advice:

1. Age alone does not necessarily rule out surgery
2. Overall health assessment is important
3. Minimally invasive surgical options may be available
4. SCS is relatively less invasive (typically 1-2 weeks of hospitalization, 2-4 weeks of recovery)
5. For elderly patients where surgical risk is high, SCS should be considered

4. Final Checklist and Questions

Final Checklist Before Making Your Decision

Confirmation List

• I understand my symptoms accurately
• I understand my diagnosis (condition name)
• I am aware of the available treatment options
• I understand the pros and cons of each treatment
• I have asked my doctor about anything I am unsure of
• I have considered getting a second opinion (if appropriate)
• I have discussed the options with my family
• I have organized my own hopes and priorities

Next Steps

Once you have a sense of the treatment direction, these pages can help further.

Questions for Your Doctor Detailed Treatment Comparison SCS Detailed Guide

Questions to Ask Your Doctor (Treatment Selection Edition)

Depending on your situation, consider asking your doctor:

For Everyone

1. "How severe are my symptoms? (Mild / Moderate / Severe)"

   • Gives you an objective assessment and shows how urgent treatment is

2. "With my current condition, what are my chances of returning to normal daily life?"

   • Helps set clear treatment goals and realistic expectations

3. "How much longer should I continue conservative treatment? What is the chance of improvement?"

   • Shows when conservative treatment has reached its limits and when to plan the next step

If You Are Considering Surgery

4. "In my case, do the imaging findings match my symptoms? Is the compression site clear?"

   • Confirms whether surgery is appropriate and gives you a basis for comparing it with SCS

5. "What is the likelihood that surgery will completely relieve my pain?"

   • Tells you the limits of surgery and the risk of pain that persists after it

6. "If I choose not to have surgery, what are the risks?"

   • Tells you the risks of avoiding surgery

If You Are Considering SCS

7. "Am I a pre-surgical or post-surgical SCS candidate?"

   • Clarifies which patient group you belong to

8. "In my case, which has a higher success rate -- SCS or surgery?"

   • Gets an evidence-based estimate for your own case

If You Are Undecided

9. "Should I get a second opinion? Can you recommend a specialist?"

   • Finds out whether another expert view is needed before a complex decision

10. "How much time do I have to decide? Do I need to decide quickly?"

    • Confirms how much time you have so you can decide without rushing

11. "How would each treatment option affect my quality of life? (Work, hobbies, housework, etc.)"

    • Covers the practical effect on your daily life as well as medical outcomes

12. "What do patients in a similar situation to mine usually choose?"

    • Shows what others in your position have chosen

Tip: Print the "Treatment Consultation Sheet" and the "Final Checklist" from this page and bring them to your appointment. Asking "Which pattern does my situation match?" can get you a more specific explanation from your doctor.

Find an SCS Center Near You (日本語): search for facilities that perform SCS

Next Steps

Detailed Treatment Comparison: cost, risk, and long-term outcome data

SCS Detailed Guide: devices, surgery, and post-implantation life explained in detail

Questions for Your Doctor: what to ask before making a treatment decision

SCS and Psychological Preparation: preparing yourself mentally before treatment

This page provides medically accurate information, but it is not a substitute for professional medical advice. Please consult your doctor for diagnosis and treatment tailored to your individual situation.