Removal of a Spinal Cord Stimulator: What to Expect

Removing a spinal cord stimulator is a surgical procedure that reverses the original implantation, typically under general anesthesia, and involves extracting the leads from the epidural space, the extension cables, and the implanted pulse generator (IPG) from its pocket under the skin. For most people, the surgery takes roughly one to two hours and is less involved than the initial implant, though that depends on how long the device has been in place and whether scar tissue has formed around the leads. The reasons for removal vary widely, and the experience afterward differs depending on why the device came out in the first place.

Why Spinal Cord Stimulators Get Removed

The single most common reason for removal is that the stimulator stopped providing adequate pain relief. In one study examining paddle-type systems, about three-quarters of explantations were driven by inadequate pain control, followed by hardware discomfort at about a fifth of cases, and the need for MRI access in roughly one in ten.¹ A separate analysis looking at both paddle and percutaneous leads found an even higher proportion, around four in five removals, attributed to loss of stimulation effectiveness, with electrode migration accounting for about one in seven.² The pattern is consistent across studies: the device simply stops doing its job for many patients over time.

Less common but still significant reasons include infection at the implant site, painful sensations caused by the stimulation itself, allergic reactions to the hardware materials, and resolution of the original pain condition. Some patients also develop complications like weakness or muscle spasms. In rare cases, a patient may need the device removed specifically to undergo an MRI that is not compatible with their particular implant model.

How Common Is Removal

Removal rates are higher than many patients expect going in. In a retrospective analysis of 100 patients, more than half ultimately had their stimulator removed entirely. About a third underwent at least one revision surgery first, and of those revised patients, a majority still ended up having the system taken out.³ The median time from implantation to removal was a little over three years, though some patients kept their devices much longer and others had them removed within months.

When removal happens very early, it tends to follow acute surgical complications. Among patients who developed infections, hemorrhages, or immediate neurological problems after implantation, the median time to removal was about two months.² This contrasts sharply with the more gradual loss of effectiveness that drives the majority of later removals.

Certain health conditions appear to raise the likelihood that a stimulator will eventually need to come out. A retrospective cohort study found that patients with sleep disorders and urinary dysfunction had a statistically elevated risk of early explantation, while cardiovascular disease also trended toward higher removal rates though with less certainty.⁴ These associations likely reflect the complexity of chronic pain in patients with multiple overlapping conditions rather than something specific about the stimulator’s interaction with those diseases.

What the Surgery Itself Looks Like

The removal procedure generally mirrors the implantation in reverse. You are placed under anesthesia, and the surgeon reopens the incision sites to access the pulse generator pocket and the leads. The IPG is disconnected and lifted out, followed by careful extraction of the extension cables and the electrode leads from the epidural space. For percutaneous (wire-type) leads, the surgeon typically pulls the leads out through the original entry point. For paddle leads, which sit flat against the spinal cord and were placed through a small laminotomy, the approach is more involved because the surgeon needs to reopen that window in the vertebra.

The difference in complexity between these two lead types shows up in the operating room data. Paddle lead operations average roughly an hour and 40 minutes with about 35 milliliters of blood loss, while percutaneous lead procedures run closer to an hour and 15 minutes with substantially less bleeding.⁵ Despite the greater invasiveness of paddle replacement or removal, complication rates between the two types were not significantly different in that analysis.

Most patients go home the same day or the next morning, depending on the complexity of the case and the surgeon’s preference. You can expect soreness at the incision sites for a few weeks and some restriction on bending, twisting, and heavy lifting during the healing period, much like after the original implant. The generator pocket site, often in the buttock or lower abdomen, tends to heal quickly since it involves only soft tissue.

The Scar Tissue Problem

One factor that can significantly complicate removal is fibrosis, or scar tissue, that forms around the leads over time. Your body treats the implanted electrodes as foreign objects and gradually encases them in fibrous tissue. This is a normal biological reaction, but it can make extracting the leads much harder, especially when the device has been in place for many years.

The materials used in epidural electrodes, including platinum, iridium alloy, polyurethane, and epoxy resin, can trigger a chronic inflammatory response that produces dense fibrotic growth around the lead tips.⁶ In some patients, this scar tissue is thick enough to cause problems even before removal is considered. One reported case involved a patient whose cervical paddle lead developed such a large fibrotic mass after seven years that it compressed the spinal cord, causing progressive weakness and requiring a multi-level laminectomy to remove both the device and the scar.⁷

For surgeons, scar tissue means the leads cannot simply be pulled free. When fibrosis is dense, the extraction becomes a delicate dissection to avoid damaging the dura or the spinal cord itself. This is one reason why the length of time a stimulator has been in place matters for surgical planning. A device implanted for a year is generally much simpler to remove than one that has been sitting in the epidural space for a decade.

Risks and Complications of Removal

Removal is generally considered lower-risk than the original implantation, but it is not without potential problems. The most concerning complications are rare but worth understanding before you go in.

Lead fracture: Older or heavily encased leads can break during extraction. In one documented case, a nine-year-old paddle lead fractured completely during removal, leaving a fragment behind. The surgeons elected to leave the fragment in place rather than risk further damage, and fortunately the patient experienced no new neurological problems afterward.⁸
Epidural hematoma: Bleeding into the epidural space after lead removal is uncommon but can happen, particularly in patients with clotting abnormalities. A case involving a cancer patient with chronic low platelet counts showed an acute epidural hematoma after trial lead removal, even after platelet transfusions had been given. The hematoma resolved without surgery and caused no lasting damage.⁹
Dural tear: If scar tissue is tightly adherent to the dura, separation during removal can cause a small tear, leading to a cerebrospinal fluid leak and positional headaches. These usually resolve on their own or with a blood patch procedure.
Wound infection: As with any surgery that reopens prior incision sites, there is a risk of postoperative infection at the wound.

Your surgeon will review your specific risk profile beforehand. Patients on blood thinners, those with compromised immune systems, or people whose devices have been in place for many years typically warrant extra precautions or imaging before the procedure.

When Infection Forces the Decision

Infection at the implant site sometimes drives the removal timeline, and how it is managed depends on where the infection is and how deep it goes. Superficial infections around the generator pocket can sometimes be treated with wound revision and antibiotics without removing the device. In a study of stimulation-related infections, about a third of cases were managed this way, often with the pulse generator simply relocated to a fresh pocket nearby.¹⁰

Deeper infections, particularly those involving the leads and extension cables or showing wound breakdown, almost always require partial or complete hardware removal. That same study found that about six in ten infected patients underwent removal of some or all of the hardware, with infections around the leads and cables slightly more likely to necessitate full explantation than infections limited to the generator pocket.¹⁰ After removal, the infection is treated with intravenous antibiotics, and the wound is allowed to heal fully before any reimplantation can be considered.

Can You Get a New Stimulator After Removal

If the stimulator was providing meaningful pain relief before the issue that led to removal, reimplantation is an option, though the timing and feasibility vary by situation. When infection was the cause, surgeons typically wait until the infection has fully cleared before placing a new device. One documented case of successful reimplantation after an infection-related removal described a waiting period of about a year before the new system was placed.¹¹

Reimplantation is not always straightforward, though. Epidural scarring left behind from the first device can make threading new leads into position significantly harder. One case report described a patient whose second stimulator was implanted with great difficulty because of widespread epidural scarring from the prior device. The procedure caused a positional headache that resolved on its own, and the new implant ultimately provided more than half reduction in the patient’s pain.¹² This suggests reimplantation can work for the right patients, but surgeons need to plan for the added complexity of navigating scar tissue in the epidural space.

For patients whose stimulator was removed because it never worked well in the first place, rather than because of a hardware or infection problem, the conversation shifts to alternative pain management strategies. These might include medication adjustments, physical therapy, interventional procedures like nerve blocks, or other neuromodulation technologies such as dorsal root ganglion stimulation or peripheral nerve stimulation. The decision depends heavily on the underlying pain condition and why the first device failed.

What Happens to Pain After the Device Comes Out

One of the biggest concerns patients have is what their pain will feel like once the stimulator is gone. The honest answer is that it depends entirely on the reason for removal. If you were among the majority who had the device removed because it was no longer providing relief, you may not notice a dramatic change, since the stimulator was already underperforming. Your baseline pain without stimulation coverage becomes your new reality, and your pain management team will work with you on alternative approaches.

If the device was working well but had to come out for a non-pain-related reason, such as an MRI requirement, an infection, or hardware failure, the return of unmasked pain can be jarring. Some patients describe it as feeling like their pain condition reset to where it was before the implant. This is why reimplantation conversations typically start quickly in these cases. Your doctor should discuss a bridge plan for managing pain in the interim, whether that involves medications, injections, or other interventions.

There is also a psychological dimension. Living with a chronic pain device that then gets removed can feel like a setback, especially if you had hoped the stimulator would be a long-term solution. Making sure you have support from your pain management team and, if needed, a psychologist or counselor who understands chronic pain can make the transition easier.

Retained Fragments and MRI Considerations

In cases where a lead fragment breaks off and cannot be safely extracted, the piece is left in the epidural space. This understandably raises concerns about whether the fragment will cause problems down the road, particularly regarding future MRI scans. A retained lead fragment is a piece of metal sitting near the spinal cord, and MRI machines use powerful magnetic fields.

In vitro testing of fragmented, open-coil lead pieces has shown that MRI artifacts extend roughly 7 millimeters from the fragment, meaning anatomical structures beyond that distance can still be visualized on the scan.¹³ Whether an MRI can safely be performed with a retained fragment depends on the specific fragment type, its location, and the MRI protocol being considered. This is a conversation between your surgeon, your radiologist, and the device manufacturer. The fragment from the fractured paddle lead case mentioned earlier remained in stable position on follow-up imaging and caused no neurological issues, but each situation is assessed individually.⁸

Even after a clean removal with no retained fragments, some patients wonder whether the epidural scarring left behind will cause issues. For most people, fibrotic tissue from a removed stimulator does not produce symptoms. The scar tissue remodels slowly over time and tends to stabilize. The rare cases of symptomatic scar tissue compressing the spinal cord, like the cervical case that required laminectomy, involved thick fibrotic growth that had been building for years while the device was still in place. Once the foreign body stimulus is removed, the inflammatory drive behind scar formation diminishes.

Preparing for the Procedure

If you have a removal scheduled, the preparation is similar to most spinal surgeries. Your surgeon will likely order imaging to assess the current position of the leads and look for any signs of migration or scar tissue buildup. You will be asked to stop blood thinners and anti-inflammatory medications ahead of the surgery, with specific timing depending on the medication. Make sure your surgeon knows about all supplements you take, since some (like fish oil and vitamin E) can also affect bleeding.

Plan for a few weeks of limited activity afterward. While recovery from removal is typically faster than from the initial implant, you still have incisions healing over the spine and at the generator site. Most people return to normal daily activities within two to four weeks, with full recovery taking a bit longer depending on the extent of the procedure. If yours involved significant scar tissue dissection or a laminectomy, recovery may stretch further.

Before the surgery, it is worth having a detailed conversation with your pain management team about the plan for afterward. If reimplantation is on the table, discuss the timeline. If it is not, establish what your next steps look like for pain control. Having that plan in place before the device comes out, rather than scrambling after, makes a real difference in how the transition feels.

1
PubMed. Spinal Cord Stimulator Explantation: Motives for Removal of Surgically Placed Paddle Systems
2
PubMed. Spinal cord stimulation failure: evaluation of factors underlying hardware explantation
3
PubMed. Timing and prevalence of revision and removal surgeries after spinal cord stimulator implantation
4
PubMed Central. Perioperative Predictors of Early Spinal Cord Stimulator Removal: A Retrospective Cohort Study
5
Neuromodulation: Technology at the Neural Interface. Revision and Replacement of Spinal Cord Stimulator Paddle Leads
6
PubMed Central. A Late Complication Related to Percutaneous Implantable Leads for Spinal Cord Stimulation: Myelopathy due to Fibrous Scar Tissue
7
PubMed. Cervical spinal cord compression from delayed epidural scar tissue formation around plate lead for SCS
8
Neuromodulation: Technology at the Neural Interface. Challenges in removing an aged spinal cord stimulator: A case study of complete fracture in a 9-year-old S-series paddle lead
9
Pain Management Case Reports. Acute Epidural Hematoma Occurring After Removal of Percutaneous Spinal Cord Stimulator Trial Leads in a Cancer Patient with Chronic Thrombocytopenia: A Case Report
10
Stereotactic and Functional Neurosurgery. Incidence and Management of Hardware-Related Wound Infections in Spinal Cord, Peripheral Nerve Field, and Deep Brain Stimulation Surgery: A Single-Center Study
11
PubMed Central. Successful Reimplantation of Spinal Cord Stimulator One Year after Device Removal Due to Infection
12
Pain Medicine Case Reports. Prior Hypermobile Spinal Cord Stimulator Removal With Difficult Reimplantation due to Epidural Scarring Provides Relief in Postlaminectomy Syndrome
13
Neuromodulation: Technology at the Neural Interface. In Vitro Magnetic Resonance Imaging Evaluation of Fragmented, Open-Coil, Percutaneous Peripheral Nerve Stimulation Leads