Spinal Cord Stimulation (SCS)

1. What SCS Is — and Its Risks

What Is SCS?

Spinal cord stimulation is a treatment in which a thin wire (called a "lead") is placed near the spinal cord in the back. The lead delivers mild electrical signals that modulate pain signaling.

A Simple Way to Think About It

If you imagine pain signals as a phone line between your body and brain:

• Your body is sending pain signals to your brain
• SCS turns down the volume on that line, making it harder for pain signals to reach the brain
• Some newer approaches also work by modulating how the brain processes pain itself

Key Points

• SCS is not open surgery, but it is a medical procedure that involves placing an electrode inside the body, with risks of infection, bleeding, and other complications
• Reversible: the device can be removed if needed, though removal is itself a medical procedure requiring clinical judgment
• If you wish, a 5-to-14-day test stimulation can be done before implanting (these days the leads and generator are more often implanted together)
• Some stimulation modes produce no tingling sensation (this varies by device and settings)

Risks and Complications — Read This First

Before considering SCS, understand the following risks.

Possible Complications

What You Should Know About These Risks

• The complications listed above are not rare. Anyone considering SCS should understand that these can and do occur
• Complication rates vary depending on the device type, the experience of the center, and the patient's condition
• Newer devices have reported improvements, but risk is not eliminated
• Some complications can be managed with device reprogramming; others may require additional surgery or device removal

Ask your doctor: "What is the complication rate at your center?" and "What types of complications are most common?" Get a clear explanation of the specific risks in your case.

2. Who Is (and Isn't) a Candidate

When SCS Is Not Appropriate

SCS is not recommended in the following situations:

• Conservative treatments (physical therapy, medications, psychological approaches) have not been tried adequately
• There is a clear structural problem that can be treated surgically (e.g., spondylolisthesis, unstable fracture)
• Severe depression or anxiety disorder is present and not adequately managed
• Overall health does not allow a surgical procedure
• Active infection is present

SCS is one treatment option among many. Exercise therapy, psychological support, appropriate medication management, and other approaches may be more suitable, either alone or in combination with SCS.

When SCS May Be Considered

SCS is not appropriate for all chronic low back pain. It is generally considered when the following conditions are met:

3. Evidence and Technology

What Clinical Trials Have Reported

Clinical trials vs. real-world practice: The results below come from clinical trials with strict patient selection criteria. In everyday clinical practice, patients are more diverse, and outcomes may differ. Think of clinical trial results as performance under the most favorable conditions.

Key Studies

Historically, SCS was studied mainly in patients who had undergone back surgery but continued to experience pain ("failed back surgery syndrome"). More recent research has also examined SCS in patients with chronic low back pain who have not had prior surgery.

A representative clinical trial (Kapural et al., 2022; 159 patients) reported that among patients with chronic low back pain and no prior surgery, a significantly greater proportion in the SCS group achieved meaningful pain reduction compared to those receiving conventional medical management alone. Several other trials have reported similar findings (Kapural et al., 2015; Eldabe et al., 2020).

However: These results come from patients who met strict eligibility criteria. Outcomes in a general clinic setting may differ. Also, many SCS clinical trials are funded by device manufacturers.

When SCS Does Not Help

• Even in clinical trials, 10–20% of patients did not achieve meaningful improvement
• The effect may not be enough, during a trial or after implantation. In that case, other treatments are explored
• Even when SCS helps, it does not eliminate pain entirely. It aims to reduce pain, not cure it

Advances in Technology

Earlier SCS devices worked by creating a tingling sensation that masked pain. Newer approaches modulate pain signals in different ways.

Several different stimulation modes are now available, and each has been studied in clinical trials (Hayek et al., 2015). Which mode is appropriate depends on the patient's condition and type of pain. This is a decision to make with your doctor.

Key features of some newer approaches:

• No tingling sensation, so natural feeling is preserved
• Stimulation remains stable with changes in posture
• Comfortable during sleep

4. Treatment Process and Cost

The SCS Treatment Process

Step 1: Specialist Consultation

The first step is an evaluation by a doctor experienced in SCS. Your treatment history, pain condition, imaging studies, and psychological assessment are all reviewed to determine whether SCS is appropriate for you.

Step 2: Test Stimulation (If You Wish)

If you wish, test stimulation can be done before the permanent implant. However, because many people find it hard to judge the effect in such a short period, and because of the risk of infection, the leads and generator are now more often implanted together in one operation. When test stimulation is done, it goes like this:

• A thin electrode is placed under local anesthesia (a short hospital stay is typically required)
• Over 5 to 14 days, you evaluate the effect during your daily life
• If pain improves by 50% or more, you proceed to permanent implantation
• If the effect is insufficient, the electrode is removed

Test stimulation itself carries risks, including infection. It is not something to try casually.

Step 3: Permanent Implantation

When implanting in one go, or when a trial has shown a good response, a permanent device is implanted:

• The electrode and a small device containing a battery (the "generator") are placed inside the body
• The generator is placed under the skin near the upper buttock area (about half the size of a business card, and about 1 cm thick)
• The procedure typically takes 1 to 2 hours
• A hospital stay of several days is usually required

Step 4: Follow-Up

• Regular clinic visits for device programming adjustments; on top of that, you can adjust the stimulation yourself with the remote to match day-to-day changes in pain
• Battery replacement is eventually needed: for rechargeable units it depends on the device and on how the stimulation is delivered and how strong it is; for non-rechargeable units it varies widely with stimulation settings, and replacement is often needed within a few years
• Stimulation patterns can be adjusted as your pain changes over time

Insurance and Cost

Coverage Varies

Insurance coverage for SCS varies by country, region, and insurer. In many countries, SCS is covered by public or private health insurance when specific medical criteria are met.

• In Japan, SCS is covered by the national health insurance system, including both the trial stimulation and permanent implantation. The high-cost medical care benefit system caps out-of-pocket expenses.
• In the United States, Medicare and most private insurers cover SCS for approved indications, though prior authorization is often required. Out-of-pocket costs depend on your plan.
• In Europe, coverage varies by country. Many national health systems cover SCS, but eligibility criteria differ.
• In other regions, check with your local insurer or healthcare provider about coverage.

Cost Considerations

Actual out-of-pocket costs depend on your insurance plan, age, income bracket, and other factors. Rechargeable vs. non-rechargeable devices also differ in long-term battery replacement costs. Discuss specific costs with your treatment center.

5. Questions and Summary

Frequently Asked Questions

Medication Use After SCS

Several studies have reported that patients reduce their use of pain medications after SCS, including opioids (strong painkillers).

However, this does not apply to everyone. Some patients continue to need medication even after SCS implantation.

Lumbar Spinal Stenosis (LSS) and SCS

This site also provides detailed information about SCS for lumbar spinal stenosis. If you have both chronic low back pain and spinal stenosis, SCS may be considered from both perspectives.

Learn more about SCS for spinal stenosis → Spinal Cord Stimulation

Summary

• SCS is one treatment option that may be considered when conservative treatments have not provided sufficient relief for chronic low back pain
• Complications are a real possibility: infection, lead migration, hardware problems, and the potential need for reoperation
• Clinical trials have reported pain improvement in many patients, but results vary between individuals, and some patients do not respond
• Even when effective, SCS reduces pain rather than curing it
• Implantation is usually done in one operation; test stimulation is available if you wish, but it carries its own risks
• Insurance coverage varies by country and insurer, so check with your provider
• Reversible: the device can be removed if needed, though this requires a medical procedure
• The decision to pursue SCS should be made in close consultation with your doctor, after considering all available treatment options

Key References

Conflict of Interest Disclosure: This website is operated by a spine surgeon who performs SCS procedures. This means there is a financial interest in SCS treatment. This page presents not only the potential benefits but also the limited eligibility, the risk of complications, and the possibility that SCS may not help. Your final treatment decision should be made with your doctor after considering all available options, including non-surgical approaches.

1. Kapural L et al. "Treatment of nonsurgical refractory back pain with high-frequency spinal cord stimulation at 10 kHz: 12-month results of a pragmatic, multicenter, randomized controlled trial." J Neurosurg Spine. 2022;37(2):188-199. (co-authors include employees of the device maker, Nevro Corp.)
2. Eldabe S et al. "The Effectiveness and Cost-Effectiveness of Spinal Cord Stimulation for Refractory Pain." Health Technol Assess. 2020.
3. Hayek SM et al. "Neuromodulation therapy utilization." Pain Med. 2015;16(7):1455-1468.
4. Kapural L et al. "Comparison of 10-kHz High-Frequency and Traditional Low-Frequency Spinal Cord Stimulation." Anesthesiology. 2015;123(4):851-860.

Next Steps

• The Big Picture — A Step-by-Step Treatment Approach
• Surgery — What You Should Know
• SCS for Spinal Stenosis — Detailed Information
• Living Well with Back Pain — Practical Tips