The procedure typically occurs in two stages. First, a trial: thin electrode leads are placed in the epidural space under X-ray guidance through a needle in the back. These are connected to an external battery for a trial period of one to two weeks. If the trial provides at least 50% pain relief, the permanent system is implanted: the leads are connected to a small battery pack (pulse generator) implanted under the skin, usually in the buttock or lower abdomen. The trial takes one hour; permanent implantation takes one to two hours.
Spinal cord stimulation is considered for failed back surgery syndrome, complex regional pain syndrome, neuropathic pain in the limbs, and certain types of chronic pain that have not responded to medication, injections, physiotherapy, and other interventions.
Pain medication, physiotherapy, psychological pain management programmes, nerve blocks, radiofrequency denervation, and other neuromodulation techniques.
Psychological assessment is usually required. A multidisciplinary pain team assessment. The trial period is essential before permanent implantation.
Approximately 50-70% of carefully selected patients achieve at least 50% pain reduction. The stimulator can be adjusted and reprogrammed over time. It is reversible — the device can be removed.
Lead migrationCommon
The electrode leads may move from their optimal position, requiring repositioning. Occurs in approximately 10-15% of patients.
Pain at battery siteCommon
Discomfort at the pulse generator implant site.
Incomplete reliefCommon
Not all patients achieve adequate pain relief.
InfectionUncommon
Infection of the leads or pulse generator. Risk approximately 3-5%. May require device removal.
Epidural haematomaRare
Blood collection around the leads. Rare but potentially serious.
Nerve injuryRare
During lead placement. Very rare.
CSF leakRare
From dural puncture during lead placement.
Hardware failureLong-term
Lead fracture or battery failure.
Local anaesthesia with sedation for the trial. General or local anaesthesia for permanent implantation.
After the trial, normal activities with care to avoid lead displacement. After permanent implantation, avoid heavy lifting, bending, and twisting for six to eight weeks while the leads stabilise. The stimulator is programmed and adjusted over subsequent visits.
Programming sessions at two weeks, six weeks, and regular intervals. Battery replacement every five to ten years depending on usage.
Will I feel the stimulation?
Modern devices offer various stimulation patterns. Some produce a gentle tingling sensation; others provide sub-perception therapy that you cannot feel.
Can I have an MRI with a stimulator?
Some modern stimulators are MRI-conditional, meaning MRI can be performed under specific conditions. This should be discussed before implantation.
Is it permanent?
The device can be removed if it is not effective or no longer needed. It is a reversible treatment.