A spinal cord stimulator (SCS) is an implanted electronic device that delivers mild electrical pulses to the spinal cord to interrupt pain signals traveling to the brain. The primary goal of this technology is to manage chronic, intractable pain when conservative treatments have failed. The device’s presence introduces specific, permanent safety and lifestyle requirements necessary to protect both the implanted technology and the patient. Understanding these long-term management protocols is crucial for maintaining the system’s effectiveness and preventing complications.
Restrictions Related to High-Energy Medical Procedures
The most stringent permanent restrictions involve high-energy diagnostic imaging and therapeutic procedures, which pose a serious risk of damaging the internal components of the SCS. Patients must carry their SCS Patient Identification Card at all times to alert medical staff before any procedure is initiated.
A key concern is Magnetic Resonance Imaging (MRI), as the powerful magnetic fields can cause the electrical leads to heat up, potentially resulting in severe tissue damage or lead migration. While many newer SCS models are considered “MR Conditional,” meaning they can be used safely under specific circumstances, strict protocols must be followed. These protocols often require the device to be set to a special “MRI Mode,” the battery to be fully charged, and the scan performed within defined limits. Older or non-conditional devices are absolutely contraindicated for MRI.
Diathermy, a therapeutic technique using high-frequency electromagnetic energy, is an absolute, permanent contraindication for all SCS patients. The energy can be transferred through the implanted system, causing intense heat at the lead tips and resulting in severe injury or tissue damage, even if the stimulator is turned off. Other high-energy medical procedures, such as therapeutic ultrasound, radiofrequency (RF) ablation, and high-output lithotripsy, must be avoided or managed with extreme caution under the guidance of the SCS team.
Managing Environmental Electromagnetic Interference
Patients must manage exposure to common environmental sources of electromagnetic interference (EMI) that can temporarily affect the SCS function. Strong electromagnetic fields can cause the stimulator to turn off or result in temporary, unpredictable changes in stimulation, which may be perceived as a jolting or uncomfortable sensation. While this interference is generally not permanently damaging, it can be distracting and uncomfortable for the patient.
For common consumer electronics like mobile phones and smart watches, maintain a minimum distance of 15 centimeters (about 6 inches) from the implanted pulse generator. Patients should not store these devices in a pocket directly over the generator site. Stronger magnetic sources, including large industrial motors, arc welders, power generators, and large stereo speakers, should be avoided or approached with caution. Theft detectors and anti-theft tag deactivators in retail stores can also cause temporary interference; patients should move quickly through the center of these gates to minimize exposure.
Physical Activity and Movement Limitations
Permanent restrictions on physical activity are necessary to protect the mechanical integrity of the implanted hardware, specifically the thin electrical leads near the spinal cord. Sudden, excessive, or repeated twisting, bending, or stretching of the spine must be avoided long-term to prevent the leads from migrating out of position or fracturing. Lead migration is a common complication that can result in a loss of pain relief or a change in stimulation, often requiring surgical correction.
High-impact sports or activities that involve repetitive jarring motions, such as competitive running, contact sports, or jumping, should be approached with caution or avoided entirely, as they increase the risk of hardware damage. Specialized activities like scuba diving below a depth of 10 meters are permanently restricted due to pressure changes affecting the sealed device components.
A separate restriction involves the operation of vehicles and heavy machinery. Patients who experience a tingling sensation (paresthesia) from their stimulation therapy must turn the device off before driving or operating potentially dangerous equipment. This precaution is necessary because a sudden change in body posture can cause an unexpected and distracting change in stimulation intensity, which could lead to an accident.
Travel and Security Screening Protocols
Navigating public security checkpoints, especially in airports, requires specific, permanent compliance protocols. The metallic components of the SCS, including the pulse generator and leads, will activate metal detectors and may be visible on full-body scanners. It is mandatory for patients to carry their official SCS Patient Identification Card, which provides essential information about the implanted device for security and emergency personnel.
When approaching a security checkpoint, the patient should proactively inform the security agent about the stimulator and present the identification card. Security agencies recommend requesting a manual pat-down and a visual inspection of the device area as an alternative to passing through electronic screening equipment. If a walk-through metal detector or body scanner must be used, the patient should move through quickly to minimize the duration of the electromagnetic exposure. The SCS should be turned off before passing through any security screening system to prevent temporary interference.