Treatment Decision Guide

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

A helpful way to think about it -- consider it step by step: When surgery is recommended, organizing your thoughts around 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 SCS first -- which is less invasive -- may be a reasonable approach.

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 -- not only for those who cannot have surgery, but also 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. Use a trial to confirm effectiveness before permanent implantation

An important perspective: SCS is not "a compromise for people who cannot have surgery." It is an effective treatment option for neuropathic pain. Particularly when multi-level fusion is needed, 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. With a success rate of 60 to 80%, it is one of the best indications for SCS

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