Getting a spinal cord stimulator does not carry any permanent restrictions. In fact, most patients who move forward with a spinal cord stimulator after a successful trial period have fewer limitations than prior to having the stimulator when they were experiencing uncontrolled pain. I have many patients who were very limited in terms of what activities they could enjoy before getting their spinal cord stimulator and now they are more active–golfing, skiing, hiking–than they have been in years.
While there are no permanent restrictions for spinal cord stimulators, there are temporary restrictions after the procedure. I often tell my patients that the first two weeks after spinal cord stimulator surgery are the most restrictive as I want to ensure patients have time to properly heal. During this initial postoperative period, patients should not do anything that requires being submerged in water, like bathing, swimming, or sitting in a hot tub. This will reduce their risk of infection.
Patients should also avoid bending, twisting, stretching or jumping as the electrodes that were placed during surgery and held in place with sutures are still healing. This means no activities like yoga, golf, or skiing. Walking and light exercise are typically fine for most patients but you should talk about your specific restrictions with your neurosurgeon.
After the initial two week period, if the patient is recovering well, I advise them to slowly start back to their activities. So, for instance, if you regularly golfed before needing your spinal cord stimulator, I would recommend you start with short-game golf. See how things feel and make sure you’re not experiencing any tugging or pulling. Then gradually increase your activity and motions from there. Here’s another example. If you love to do ski jumps, start with skiing easier runs, then work up to tougher runs, and then gradually add in jumps. That is, don’t start right out of the gate with jumps.
Living with a spinal cord stimulator
The main benefit of spinal cord stimulators are a reduction in pain for people with uncontrolled back, neck, or arm pain or for some people who suffer from conditions like diabetic neuropathy. During a spinal cord stimulator trial, the goal is a reduction in pain of at least 50% in order to be considered a successful candidate for a spinal cord stimulator. With the incredible advancements in spinal cord stimulation technology as well as improved criteria for patient selection, nearly all of my spinal cord stimulation patients find significant pain relief and improved quality of life. I believe one of the most important aspects of this success is clearly outlining the intricacies of living with spinal cord stimulator. There are some temporary restrictions as well as expectations of patients–based on what type of spinal cord stimulator they have. Living with a spinal cord stimulator should be less burdensome than living with uncontrolled pain.
Below are some commonly asked questions patients ask me when they are considering a spinal cord stimulator.
What am I going to feel once my spinal cord stimulator is placed?
I think it’s important that all patients who are considering a spinal cord stimulator understand that you will feel the generator/battery under your skin. It will gradually become something you get used to, but it does feel weird for a bit–it’s a foreign object just under your skin. It will be a little mobile and move with the fatty tissue (not far but it’s not attached to any muscle or bone so it will shift slightly).
Some patients may also experience vibratory sensations in their feet or hands or a humming background sound depending on the level of stimulation being used. There are different stimulation levels you can change, and your neurosurgeon will work closely with you to find the ideal settings so you don’t feel anything, including pain. Our goal is to eliminate your pain without adding other side effects like vibration. Most of the time, people are really happy with their spinal cord stimulator benefits even if they experience minor side effects from time to time. But I do have patients that are fairly annoyed by humming or vibration and we work closely with them to fine-tune their stimulation.
What are the different types of spinal cord stimulators, and what impact will they have on my life?
This is a question that many of my patients need time to think through. I work closely with my patients to understand their goals and expectations of spinal cord stimulation so that they choose options that work best for them.
Here are what I see as the big decision points in terms of types of spinal cord stimulator devices:
- Rechargeable battery vs. non-rechargeable battery: Patients can now select a spinal cord stimulator that they can charge themselves by wearing a belt for roughly an hour at a time. These devices are newer, and from what we can tell so far, they may last indefinitely for patients, meaning a follow-up surgery to replace the device is not necessary. On the other hand, spinal cord stimulators with non-rechargeable batteries typically last for 5-7 and even up to 10 years for patients. These devices do not require any effort by the patient to recharge them, but when the battery runs its course, the patient must undergo another surgery to replace the device. As with any surgery, there’s a small risk of infection and complications, and the patient will have some recovery time. One of the upsides to a non-rechargeable spinal cord stimulator device is that technology is advancing so rapidly, when patients need a new battery, then get the latest technology or switch to even consider switching to a rechargeable battery. At this point, there’s no way to update the technology for the rechargeable battery spinal cord stimulators unless you choose to undergo another surgery to replace the device.
- Paddle vs. percutaneous leads: The electrodes placed during spinal cord stimulator surgery can either be placed by a paddle procedure or percutaneously. The percutaneous approach uses an approach similar to an epidural needle and only light sedation is necessary. There is no incision. The downside to this approach is that there are fewer options for where the leads can be placed, which may not provide optimal pain relief for some patients. For patients who may not be good candidates for full surgery, the percutaneous option is safest. Unlike the percutaneous approach, during the paddle approach for spinal cord stimulation, we surgically secure the leads to the spinal column and have more options in terms of where we can place the leads to target pain signals. Both options can be highly successful based on the patient, their health, and their pain relief needs.
Are there any issues with getting an MRI with a spinal cord stimulation device?
The spinal cord stimulators we use at Neurosurgery One are all compatible with MRI machines, so you shouldn’t need to worry about future imaging obstacles. However, it’s important you discuss the specifics of the spinal cord stimulator you choose with your neurosurgeon to be sure.
Can I drive with a spinal cord stimulator?
Because the spinal cord stimulator sends mild electrical signals, you should not have the device on while driving or operating heavy machinery. You can certainly ride as a passenger in a moving vehicle though and keep your spinal cord stimulator powered on while doing so.
Will I have issues going through security screening at an airport?
With the new spinal cord stimulation devices, they do not always show up in metal detectors but will likely be detected in the millimeter wave scanner that many TSA checkpoints use today. It’s always smart to travel with documentation that verifies what medical device you have implanted.
What if someone I know tried spinal cord stimulation and it didn’t work?
You may have a friend or family member who tried spinal cord stimulation years ago and it didn’t relieve their pain or it didn’t work like they expected. This is more common than you might think. There are two main reasons for this:
- The reality is that the spinal cord stimulation technology has improved so much in the past decade that it’s now a much more effective option for many patients. In fact, there’s great evidence that spinal cord stimulation can be effective for more indications like diabetic neuropathy.
- Criteria for identifying viable candidates for spinal cord stimulation have greatly improved. We have a much better understanding of what conditions will benefit from spinal cord stimulation, which patients will respond to the treatment well, and how to educate patients so they get the greatest benefit from the device.
Spinal cord stimulation is a highly effective option for many patients suffering from unresolved back, neck, leg, or arm pain or other conditions like diabetic neuropathy, peripheral vascular disease, or a spinal cord injury. With no permanent restrictions, I highly encourage patients to consider the treatment if more conservative options are not effective.
Zain Allison, MD, is a neurosurgeon and spine surgeon based in Lakewood, Colorado. Dr. Allison specializes in spinal and cranial neurosurgery and minimally invasive and traditional spine surgeries including spinal cord stimulation. He is currently working toward becoming board certified by fulfilling his post-residency practice requirement.