A spinal cord stimulator (SCS) is an implanted device that delivers a low-voltage electrical current to the spinal cord, effectively masking pain signals traveling to the brain. This neurostimulation therapy can significantly reduce chronic pain for many individuals who have not found relief through other treatments. The device consists of an internal pulse generator and thin wires, known as leads, placed in the epidural space near the spinal cord. Adherence to permanent safety guidelines and restrictions is required to protect the patient from injury and the hardware from damage or malfunction.
Interactions with Medical Imaging and Procedures
The presence of an implanted electronic device necessitates permanent precautions regarding certain high-energy medical procedures and diagnostic imaging. The most significant concern involves Magnetic Resonance Imaging (MRI), which uses powerful magnetic fields and radiofrequency waves. Older or incompatible SCS systems are strongly contraindicated for MRI because the magnetic field can cause the device leads to heat spinal tissue, potentially leading to severe thermal injury, or cause the device to malfunction or migrate.
Newer SCS models are often classified as “MRI Conditional,” meaning they can be safely scanned only if specific manufacturer and device parameters are met. Failure to adhere to these strict conditions can cause irreversible damage to the stimulator’s electronics, requiring surgical replacement. Patients must inform all healthcare providers about their SCS device before scheduling any imaging test to determine compatibility and necessary programming adjustments.
Other medical procedures pose risks due to the use of concentrated energy sources. Diathermy, which uses high-frequency electrical currents or electromagnetic waves to produce therapeutic heat, is universally contraindicated for SCS patients. This heat energy can directly transfer to the implanted leads, causing tissue damage to the spinal cord.
Procedures like electrocautery, used during surgery, can generate enough electrical current to damage the stimulator’s internal circuitry. Monopolar electrocautery is discouraged because the current travels through the body, while bipolar cautery confines the current to a smaller area. External defibrillation (cardioversion), which delivers a high-energy electrical shock, can permanently render the SCS device unresponsive. The device must be turned off and potentially reprogrammed before this procedure.
Environmental and Security Considerations
Daily life presents environmental factors that can temporarily interfere with the SCS system, primarily through strong electromagnetic fields (EMFs). These interactions do not cause permanent damage but can disrupt the stimulation, leading to uncomfortable or sudden changes in the electrical sensation, known as paresthesia. Patients should maintain a distance from powerful industrial equipment, such as large motors, arc welders, and high-voltage power generators.
Patients frequently encounter external screening devices in public settings, which can temporarily affect the device’s function. Anti-theft systems at store exits and security screening wands or metal detectors generate electromagnetic fields that may cause the SCS to power down or deliver a brief, jolting burst of stimulation. It is advisable to turn the SCS device off before passing through security gates to prevent unintended stimulation. Modern full-body scanners do not pose the same risk of uncomfortable stimulation as older metal detectors but will detect the implanted hardware.
Physical Movement and Activity Limitations
A permanent restriction on certain physical movements is necessary to protect the integrity of the implanted leads. Excessive or repetitive strain on the torso can cause the leads to migrate away from their intended position near the target nerves, or, in rare cases, cause the wire to fracture. Lead migration is the most common hardware-related complication and can result in the complete loss of pain relief.
Activities that involve aggressive, repetitive bending, twisting, or stretching of the spine are permanently discouraged. This includes motions such as reaching overhead, performing certain yoga poses, or reaching down to tie shoes. High-impact activities that subject the body to sudden, jarring forces are also restricted, including contact sports, downhill skiing, and running or jogging.
Patients are advised to permanently avoid heavy lifting, often defined as anything exceeding 10 to 20 pounds, to prevent straining the tissues around the leads. The exact permanent weight limit is determined by the physician based on the patient’s specific anatomy and device placement. Low-impact exercises like walking, swimming, and stationary cycling are safe and encouraged after the initial post-operative healing period.
Essential Safety Protocols and Identification
Compliance with communication and documentation is a permanent aspect of living with an SCS. It is necessary to carry the official SCS identification card provided by the manufacturer at all times, especially when traveling or seeking medical care. This card contains vital information, including the manufacturer’s name, the model and serial numbers of the pulse generator and leads, and contact information.
The identification card serves two primary purposes: facilitating passage through security checkpoints and informing emergency medical personnel. In the event of an emergency where the patient cannot communicate, the card alerts first responders and hospital staff that an implanted electronic device is present, guiding decisions regarding medical interventions. Patients must also proactively inform all healthcare providers, including dentists, chiropractors, and physical therapists, about the SCS before any procedure begins to ensure that no treatment compromises the device’s function or safety.