A spinal cord stimulator (SCS) is an implanted device used to manage chronic pain, typically after other conservative treatments have not provided sufficient relief. The system uses a pulse generator placed under the skin and electrodes positioned near the spinal cord. The device delivers mild electrical impulses that interfere with or mask pain signals traveling to the brain, reducing discomfort. Successfully living with an SCS requires strict adherence to specific safety guidelines and device limitations for both personal safety and the long-term function of the technology.
Diagnostic Imaging Restrictions
The most significant restriction for individuals with a spinal cord stimulator involves Magnetic Resonance Imaging (MRI) scans. MRI machines generate strong magnetic fields and radiofrequency energy, which pose several risks to the implanted hardware. These fields can damage the pulse generator’s internal electronics, erase programming, or cause the device to fail completely.
A more immediate concern is the potential for tissue damage caused by energy transfer near the electrodes, known as the antenna effect. Radiofrequency pulses can induce currents in the leads, resulting in excessive heating at the electrode tips. This heating may cause severe burns or injury to the spinal cord tissue. The strong magnetic force also risks tugging on the implanted components or causing the device to move within the body.
The ability to undergo an MRI depends entirely on the specific SCS model implanted, a classification known as “MRI Conditionality.” Older devices are often “MRI Non-Conditional,” meaning scans are strictly prohibited. Many newer systems are “MRI Conditional,” allowing for scans only if precise manufacturer guidelines are followed. Patients must always carry their SCS identification card and inform the imaging staff, as the stimulator often needs to be turned off or placed into a specialized “MRI Mode” before the scan can begin. Imaging procedures like X-rays and Computed Tomography (CT) scans are generally considered safe, but staff must still be notified.
Environmental and Safety Prohibitions
Individuals with a spinal cord stimulator must exercise caution around external environments and devices that generate strong electromagnetic fields (EMF). Exposure to powerful magnets, such as those found in large industrial motors, arc welders, or powerful stereo speakers, can temporarily interfere with the device’s function. While most common household electronics like microwaves and cell phones are safe, standing in close proximity to high-tension power lines or generators should be avoided.
Security screening at locations like airports or courthouses requires specific protocols. Metal detectors and security wands may trigger an alarm or cause a momentary, uncomfortable surge in stimulation. Before passing through a detector, the patient should present their identification card and request a manual pat-down or an alternative screening method.
Operating heavy machinery or driving a vehicle is prohibited while the stimulator is actively adjusting its settings or producing a new sensation. Any sudden change in electrical stimulation can be distracting and may lead to a loss of control. It is advisable to ensure the device is turned off or set to a stable program before driving. Furthermore, activities involving extreme pressure changes, such as scuba diving below 30 meters (100 feet), are discouraged due to the potential effect on the implanted hardware.
Restrictions on Medical and Surgical Procedures
Certain medical procedures that use high-frequency energy are strictly contraindicated for SCS patients because they can cause severe injury. Diathermy, which uses radiofrequency, microwave, or shortwave energy for therapeutic heating, is the most prominent prohibition. Diathermy energy can transfer through the implanted leads, causing intense heating and irreparable tissue damage at the electrode-spinal cord interface.
Even if the SCS is turned off, the energy transfer risk remains, and diathermy can permanently damage the device, requiring replacement surgery. Other procedures involving electrical currents or high-output energy require careful consideration. Monopolar electrosurgery must be avoided; bipolar electrosurgery is the preferred, safer alternative.
High-output therapeutic ultrasound, lithotripsy (a procedure using shock waves to break up kidney stones), and radiofrequency ablation can also pose risks to the neurostimulation system. It is mandatory to inform every healthcare provider, including dentists and surgeons, about the presence of the SCS before any procedure is scheduled. This notification allows the clinical team to take necessary precautions and avoid contraindicated techniques.
Limitations on Physical Activity and Device Care
Immediately following the implantation surgery, patients must adhere to strict physical limitations to allow for proper healing and prevent damage to the delicate system. During the initial phase (the first six to twelve weeks), patients cannot perform activities involving excessive bending, lifting heavy objects, or strenuous twisting motions. These movements can cause the thin leads, which are placed near the spinal cord, to migrate away from their intended position or potentially fracture.
While low to moderate activity like walking is encouraged, high-impact activities such as running, jumping, or contact sports are advised against initially to protect the hardware. After the initial healing period, a gradual return to activities is possible. However, high-impact sports may be limited long-term to prevent stress on the implanted system.
Basic device care involves several prohibitions, particularly concerning the surgical incision sites. Patients must avoid submerging the incision in water, meaning swimming or using hot tubs are off-limits until the incision is completely healed and dry to minimize infection risk. The implanted pulse generator site should also be protected from direct trauma or sharp blows, as physical impact can damage the device. Finally, keep the remote control and charging accessories away from items with magnetic strips, like credit cards.