Recovery After Spinal Cord Stimulator Implant Surgery

Spinal cord stimulator implant surgery is a minimally invasive and relatively safe procedure with a recovery process that can vary considerably from one individual to the other. Recovery after a spinal cord stimulator implant depends on several factors, including but not limited to the patient's general health and how closely the care instructions are followed.

Non-surgical treatments are typically tried for 1 year before considering spinal cord stimulation (SCS). However, there may be occasions when SCS may be considered an appropriate treatment after six months of nonsurgical treatment. ¹ Thomson S, Huygen F, Prangnell S, et al. Appropriate referral and selection of patients with chronic pain for spinal cord stimulation: European consensus recommendations and e-health tool. Eur J Pain. 2020;24(6):1169-1181. doi:10.1002/ejp.1562 ^{, 2} Kriek, N., Groeneweg, J., Stronks, D. et al. Comparison of tonic spinal cord stimulation, high-frequency and burst stimulation in patients with complex regional pain syndrome: a double-blind, randomised placebo controlled trial. BMC Musculoskelet Disord 16, 222 (2015). https://doi.org/10.1186/s12891-015-0650-y

See Who May Benefit from Spinal Cord Stimulation

Spinal cord stimulation (SCS) is a two-stage process that includes a trial phase and a permanent implant phase (if the trial is deemed successful). Research on spinal cord stimulation treatment for chronic back pain is currently inconclusive and further long-term studies are needed to establish the safety and efficacy of SCS. ³ Traeger AC, Gilbert SE, Harris IA, Maher CG. Spinal cord stimulation for low back pain. Cochrane Back and Neck Group, ed. Cochrane Database of Systematic Reviews. 2023;2023(3). doi:10.1002/14651858.CD014789.pub2

Spinal Cord Stimulator Implant Surgery Recovery Time

A spinal cord stimulator implant surgery is an outpatient procedure, and most patients return home the same day after the treatment. ⁴ Dydyk AM, Tadi P. Spinal Cord Stimulator Implant. [Updated 2022 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555994/ In select patients, a hospital stay of up to 1 day may be required.

See Spinal Cord Stimulation Procedure

The average time to resume driving a motor vehicle is about 2 to 3 weeks after the surgery. ⁵ Simopoulos TT, Rosa H, Wootton J, Eichman DS, Gill JS. A survey of spinal cord stimulator use by chronic pain patients while driving. Neuromodulation: Technology at the Neural Interface. 2016;19(5):487-491. doi:10.1111/ner.12367

It may take about 6 weeks to recover ⁶ Tekmyster G, Jonely H, Lee DW, et al. Physical therapy considerations and recommendations for patients following spinal cord stimulator implant surgery. Neuromodulation: Technology at the Neural Interface. 2023;26(1):260-269. doi:10.1111/ner.13391 and return to an office or sedentary job, but it can take 6 months or longer to return to jobs requiring more demanding physical activities.

Factors That Affect the Recovery After a Spinal Cord Stimulator Implant

Recovery after spinal cord stimulator implant surgery depends on the patient's health and compliance with the treatment/post-surgical protocols.

Presence of pre-existing conditions

Conditions such as diabetes and immunosuppression may increase the risk of delayed wound healing and infection at the surgical site, delaying recovery. ⁷ Sitzman BT, Provenzano DA. Best practices in spinal cord stimulation. Spine. 2017;42(14):S67-S71. doi:10.1097/BRS.0000000000002220

Migration of the lead or lead breakage

Leads (wires) connected to the implanted pulse generator device are placed in the epidural space, which surrounds the spinal cord. These leads help deliver electrical current to the nerves. Patients who experience a fall after the implant surgery, regularly perform strenuous physical activities, or are obese are at a high risk of migration or breakage of the lead, leading to treatment failure. ⁸ Graham DT, Lambert M, Mirzadeh Z, Ponce FA. Factors contributing to spinal cord stimulation outcomes for chronic pain. Neuromodulation: Technology at the Neural Interface. 2022;25(1):145-154. doi:10.1111/ner.13515 ^{, 9} Hasoon J. Lead migration in spinal cord stimulation with loss of pain coverage in a CRPS patient. Saudi J Anaesth. 2020;14(2):280-281. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7164436/ Lead-associated problems are the most common complication associated with spinal cord stimulator implantation. ⁹ Hasoon J. Lead migration in spinal cord stimulation with loss of pain coverage in a CRPS patient. Saudi J Anaesth. 2020;14(2):280-281. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7164436/

Care after implantation

Patients who are unable to cognitively participate in their care may consider a non-rechargeable SCS generator for better recovery and results, as these generators require lower ongoing maintenance and do not require periodic charging of the battery. ⁷ Sitzman BT, Provenzano DA. Best practices in spinal cord stimulation. Spine. 2017;42(14):S67-S71. doi:10.1097/BRS.0000000000002220

Access to the necessary services and amenities

Access to the necessary facilities, equipment, healthcare providers, and support personnel for follow-up and in case of questions/concerns can help enhance overall care and speed up recovery. ⁷ Sitzman BT, Provenzano DA. Best practices in spinal cord stimulation. Spine. 2017;42(14):S67-S71. doi:10.1097/BRS.0000000000002220

Factors That Affect the Overall Outcome of SCS Treatment

Successful spinal cord stimulation outcomes largely depend on appropriate patient selection. Common factors related to patient selection are discussed below:

Success of the implant trial

If the patient achieves 50% or more pain relief during the SCS trial phase, the chances of significant pain relief after the permanent implant is higher. ⁷ Sitzman BT, Provenzano DA. Best practices in spinal cord stimulation. Spine. 2017;42(14):S67-S71. doi:10.1097/BRS.0000000000002220

The long term success of SCS also depends on the outcome of the trial. In general, the higher the percentage of pain relief during the trial, the greater the chance of long-term success with permanent implantation. ¹⁰ Hoikkanen T, Nissen M, Ikäheimo TM, Jyrkkänen HK, Huttunen J, von Und Zu Fraunberg M. Long-Term Outcome of Spinal Cord Stimulation in Complex Regional Pain Syndrome. Neurosurgery. 2021;89(4):597-609. doi:10.1093/neuros/nyab239

Timing of SCS treatment

Research indicates that patients treated with SCS earlier in relation to the onset of severe pain than later have a higher chance of successful pain relief. When appropriate, it is recommended to consider SCS treatment within the first two years of chronic pain when non-surgical treatments have either failed or are not suitable. ⁷ Sitzman BT, Provenzano DA. Best practices in spinal cord stimulation. Spine. 2017;42(14):S67-S71. doi:10.1097/BRS.0000000000002220

Type of stimulation

The type of device and the strength of the stimulation generated may affect different patients in different ways. Some research indicates that high-frequency SCS may be more effective in managing pain compared to low-frequency SCS. ¹¹ Conic, R.R.Z., Caylor, J., Cui, C.L. et al. Sex-specific differences in the efficacy of traditional low frequency versus high frequency spinal cord stimulation for chronic pain. Bioelectron Med 8, 8 (2022). https://doi.org/10.1186/s42234-022-00090-2 However, this theory is not generally applicable to everyone and varies from one patient to the other.

See Options in Spinal Cord Stimulation

New pain symptoms

Patients who develop new pain symptoms that originate after the implantation of the spinal cord stimulator device are more likely to have an unsuccessful SCS treatment. ⁸ Graham DT, Lambert M, Mirzadeh Z, Ponce FA. Factors contributing to spinal cord stimulation outcomes for chronic pain. Neuromodulation: Technology at the Neural Interface. 2022;25(1):145-154. doi:10.1111/ner.13515

Gender

Research indicates that men have better outcomes compared to women and lower usage of opioid pain medication while on SCS treatment. ¹⁰ Hoikkanen T, Nissen M, Ikäheimo TM, Jyrkkänen HK, Huttunen J, von Und Zu Fraunberg M. Long-Term Outcome of Spinal Cord Stimulation in Complex Regional Pain Syndrome. Neurosurgery. 2021;89(4):597-609. doi:10.1093/neuros/nyab239

Factors Influencing Return to Work After Spinal Cord Stimulator Implant

The recovery after a spinal cord stimulator implant and the outcome of SCS treatment largely determine the patient's return to work status. Additionally, the patient's type of work, economic status, and improvement in pain and other symptoms also play an important role in return to work after the implant surgery. This process may take several weeks, but some patients may need months to return to work. ¹² Dauriac‐Le Masson V, Gatt M, Chekroun C, Turak B, Djian MC. Spinal cord stimulation and return to work of patients with failed back surgery syndrome. Pain Practice. Published online January 27, 2023:papr.13205. doi:10.1111/papr.13205

A study involving 59 people who received SCS treatment for failed back surgery syndrome (FBSS) found ¹² Dauriac‐Le Masson V, Gatt M, Chekroun C, Turak B, Djian MC. Spinal cord stimulation and return to work of patients with failed back surgery syndrome. Pain Practice. Published online January 27, 2023:papr.13205. doi:10.1111/papr.13205 :

• Type of work. People who did heavier physical work and had no leisure-time physical activity were less likely to return to work after a spinal cord stimulator implant surgery.
• Improvement in pain. Around 50% of people who had improvement in pain returned to work after the surgery.
• Improvement in function. Around 50% of people who had improvement in function returned to work after the surgery.

The study also suggested that patients with depression and anxiety are less likely to return to work after the surgery. A multidisciplinary treatment program that aims to establish physical, psychological, and social developments is key to helping patients reintegrate into active life. ¹² Dauriac‐Le Masson V, Gatt M, Chekroun C, Turak B, Djian MC. Spinal cord stimulation and return to work of patients with failed back surgery syndrome. Pain Practice. Published online January 27, 2023:papr.13205. doi:10.1111/papr.13205

Planning Ahead for Spinal Cord Implant Surgery

It is common for patients to feel run down when first getting home after the surgery. To help ensure a smooth transition from hospital to home, it is essential to know how to improve the recovery process and get help with basic necessities from friends, family, or a neighbor.

Understanding pain control

Concerns about pain control after a spinal cord stimulator implant surgery are common. Talking with the surgeon beforehand about pain relief options helps to set realistic expectations. Patients on chronic opioid pain medication for a long period of time before the surgery may find it difficult to achieve adequate pain control early after surgery when medication is reduced.

Checking ahead of time with the surgeon about medication refills can help avoid potential delays.

Preparing the home

Preparing the home in advance also makes the recovery smooth with fewer chances of complications and problems:

• Keeping everyday items within reach. By keeping common items in easy-to-reach spots, bending and reaching are more easily avoided. A grabber device or tool can be used to pick things up off the ground or shelves avoiding the need to bend or reach up.
• Prepping/planning meals. To minimize standing and moving around the kitchen to prepare meals, stocking up on microwaveable meals or cooking and freezing food for later use is advisable.
• Asking for help. Arranging for someone to assist with heavier chores that require more strenuous physical activities, such as laundry and cleaning, may be necessary.
• Preventing falls. It is best to remove anything that may be a tripping hazard, such as loose rugs, cables, or clutter.
• Adding/installing toilet and shower equipment. Adding a shower mat, toilet riser, and shower seat makes the bathroom safer and easier to use. Some people also install handrails, as needed, such as on stairs or in the shower. Home health equipment may be covered by insurance.

Surgeons can also help suggest ideas about preparing for a return home after the implant surgery, such as whether stairs can be used or if they should be avoided for a few days. These types of restrictions can help plan the living space accordingly.

Read more about Preparation Before Back Surgery

When a Spinal Cord Stimulator Implant Recovery Setback Is Serious

Having good days and bad days during the recovery period is normal. A painful flare-up or a previously unnoticed symptom is not necessarily a cause for alarm. However, medical attention is needed if one or more of the following symptoms occur:

• Fever of at least 101 degrees
• Breathing difficulty
• Worsening of the incision site's pain, redness, or discharge
• Feelings of sadness or nervousness that are almost constant
• Constipation that is not relieved with self-care

This is not a complete list of symptoms that may point to a serious issue. Several others could exist, including the onset of or a worsening of leg weakness or problems with walking or coordination. Discussing concerning symptoms and signs with the surgeon without delay can help prevent or treat the issue and prevent potential adverse events.