Spinal Cord Stimulation (SCS)
Fellowship-trained spine surgeons • 12 hospital affiliations across New JerseySpinal cord stimulation (SCS) is an implantable neuromodulation device that delivers low-level electrical pulses to the dorsal columns of the spinal cord, interrupting the transmission of chronic pain signals to the brain. It is most commonly used for persistent neuropathic pain after spine surgery (failed back surgery syndrome), complex regional pain syndrome (CRPS), and chronic radicular pain that has not responded to other treatments.
Key takeaways
- SCS delivers electrical pulses through leads implanted in the epidural space, modulating pain signal transmission in the spinal cord.
- A trial period of 5 to 7 days with an external generator tests efficacy before permanent implantation is performed.
- Modern high-frequency and burst stimulation waveforms have replaced older tonic stimulation eliminating the paresthesia (tingling) previously associated with SCS.
- SCS is appropriate for carefully selected patients with chronic neuropathic pain who have not responded to conservative treatment and surgery.
- The implanted generator is rechargeable and typically lasts 5 to 10 years before requiring replacement.
| Mechanism | Electrical modulation of dorsal column pain signal transmission |
| Implant components | Epidural leads + subcutaneous pulse generator |
| Trial procedure | 5 to 7 day external trial before permanent implant |
| Waveforms | High-frequency (HF10), burst, tonic waveform selected per patient response |
| Anesthesia | Local anesthesia with sedation for lead placement; general for generator implant |
| Hospital stay | Outpatient for trial; 1 night for permanent implant |
| Best for | Failed back surgery syndrome, CRPS, chronic radicular pain, peripheral neuropathy |
Timing and stay vary by patient and complexity. Your surgeon will confirm what to expect in your case.
How spinal cord stimulation works
Pain signals from the body travel through the spinal cord to the brain via the dorsal columns bundles of ascending sensory fibers running along the back of the spinal cord. SCS places thin wire leads in the epidural space (the space just outside the spinal cord coverings) and delivers low-level electrical pulses that modulate the activity of these fibers, reducing the intensity of pain signals reaching the brain.
The exact mechanism is not fully understood and varies by waveform type. With older tonic stimulation, patients felt a tingling (paresthesia) replacing their pain. Modern high-frequency (10 kHz) and burst stimulation programs work below the sensory threshold patients feel no tingling, just pain relief. This has significantly improved patient satisfaction and acceptance of the therapy.
The trial period and permanent implantation
Trial phase
SCS always begins with a trial before permanent implantation. Leads are placed percutaneously in the epidural space under fluoroscopy with the patient lightly sedated patient feedback during positioning helps confirm optimal lead placement for their pain distribution. The leads are connected to an external generator worn on a belt for 5 to 7 days. If the trial achieves 50% or greater pain reduction (the standard threshold), the patient proceeds to permanent implantation.
Permanent implantation
The trial leads are replaced with permanent leads and connected to an implantable pulse generator (IPG) placed subcutaneously in the flank, buttock, or lower back. The patient controls stimulation via a handheld remote programmer. The IPG is rechargeable by placing a charging pad over the skin — typical recharge time is 1 to 2 hours per week.
Benefits and risks
Potential benefits
- Significant pain reduction in 50 to 80% of appropriately selected patients without the systemic side effects of opioid medications
- Reversible the device can be turned off or explanted if ineffective or unwanted
- Trialed before permanent commitment patients can assess benefit before proceeding
- Improves function and quality of life alongside pain reduction
Possible risks
- Lead migration -- leads can move from their optimal position, reducing efficacy; may require repositioning
- Hardware infection -- low rate but requires explantation if it occurs
- MRI compatibility -- most modern systems are MRI-conditional; confirm with your surgeon before any MRI
- Inadequate pain relief -- approximately 20 to 30% of trialed patients do not achieve sufficient relief to proceed to permanent implant
Your surgeon will review the benefits and risks specific to your diagnosis during your consultation.
What recovery looks like
Recovery from SCS implantation is straightforward:
- Trial phase Outpatient procedure. Light activity for 5 to 7 days. Avoid bending, twisting, and strenuous activity to prevent lead migration during the trial.
- Permanent implant Outpatient or 1-night stay. Activity restrictions for 4 to 6 weeks to allow lead and generator pocket to heal. Avoid raising arms above shoulders and excessive twisting.
- Weeks 4 to 6 Stimulation programming session with the device representative to optimize waveform parameters for maximum pain relief.
- Long term Annual device check. Battery status monitored by the patient via the remote programmer. IPG replacement every 5 to 10 years as needed.
Frequently asked questions
Will SCS cure my pain?
SCS does not cure the underlying cause of pain it modulates pain signal transmission to reduce the perceived intensity. Most patients achieve 50 to 70% pain reduction, which significantly improves function and quality of life. Complete pain elimination is uncommon but does occur in some patients.
Can I have an MRI with a spinal cord stimulator?
Most modern SCS systems are MRI-conditional meaning MRI can be performed under specific conditions (field strength, body region, patient positioning). Full-body MRI compatibility varies by system and lead configuration. Always inform your MRI team about the presence of an SCS device before any MRI scan. Your ABS surgeon will provide documentation of the specific device model and MRI conditions.
What happens if I do not respond to the trial?
Approximately 20 to 30% of trialed patients do not achieve sufficient relief to proceed to permanent implantation. The trial leads are removed as an outpatient procedure with no long-term consequences. Alternative pain management strategies are discussed with your care team.
Is SCS covered by insurance?
SCS is covered by Medicare, Medicaid, and most commercial insurers for FDA-approved indications including failed back surgery syndrome and CRPS. Prior authorization is required and clinical documentation of failed conservative treatment is typically needed. The ABS team assists with insurance authorization.
This page is for general education and does not replace medical advice. Treatment decisions should be made with a qualified neurosurgeon based on your individual diagnosis and imaging. To discuss your options, call Atlantic Brain and Spine Spine Care at 973.993.7770 or request a consultation.
Spinal Cord Stimulation Specialists at Atlantic Brain and Spine
Your procedure is performed by fellowship-trained, board-certified spine specialists, including neurosurgeons and orthopedic spine surgeons.
