Spinal Cord Stimulation — Procedure Guide, Recovery & Risks | MyMedicPlus

Spinal cord stimulation (SCS) delivers programmable electrical impulses to the dorsal columns of the spinal cord via epidurally placed paddle or percutaneous leads connected to an implantable pulse generator (IPG). It modulates pain signal transmission through gate-control and supraspinal mechanisms without ablating neural structures.

Primary indications include failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS Type I and II), refractory angina pectoris, painful diabetic peripheral neuropathy, peripheral arterial disease with rest pain, and post-herpetic neuralgia unresponsive to pharmacological management.

Stage 1: percutaneous leads advanced through Tuohy needles into the dorsal epidural space under fluoroscopy; positioned at T8-T10 for leg pain or C3-C5 for arm pain; paresthesia mapping confirms coverage; external stimulator connected for 7-14 day trial. If pain reduces by over 50%, Stage 2 implants IPG subcutaneously at the flank or buttock.

Day surgery or overnight stay. Wound healed by 2 weeks; heavy lifting and bending avoided for 6 weeks to allow lead fibrous encapsulation. SCS programming is refined over 3-6 months using waveform parameters (tonic, burst, high-frequency 10 kHz). Annual follow-up monitors device function and clinical response.

Lead migration occurs in 10-15% and requires surgical revision under fluoroscopy. Device infection in 3-5% may necessitate complete system removal. Epidural haematoma below 0.5%, seroma, lead fracture, IPG battery depletion, loss of efficacy over time, and MRI compatibility limitations with older devices are recognized issues.

50-70% of SCS patients achieve over 50% pain reduction at 12 months. The PROCESS RCT demonstrated SCS superior to re-operation for FBSS at 6 and 24 months with greater satisfaction and quality-of-life gains. High-frequency 10 kHz stimulation (HF10) achieves paresthesia-free pain relief with success rates of 70-80% at 12 months.