A Spinal Cord Stimulator (SCS) is an implanted medical device that manages chronic pain by delivering mild electrical impulses to the epidural space near the spinal cord. This current interferes with pain signals traveling to the brain, often replacing the sensation of pain with a tingling feeling, or in newer systems, a sensation that cannot be felt. While the SCS offers significant relief and an improved quality of life for many patients, its presence within the body means certain activities, environments, and medical procedures must be approached with caution. Adherence to specific restrictions ensures patient safety and prevents damage to the internal components.
Restrictions Immediately Following Implantation
The period immediately following surgery, lasting six to eight weeks, requires acute restriction for the leads to settle and the surgical site to heal. Excessive motion is strictly forbidden during this time to prevent the leads from migrating away from their intended position near the spinal cord. Patients must avoid movements that stretch or strain the torso, including excessive bending, twisting, or reaching the arms above the shoulder.
A temporary weight restriction limits lifting to less than five pounds (about 2 kilograms), as straining muscles can pull on the leads. To prevent infection, patients cannot submerge the implant site in water, prohibiting bathing, swimming, or using a hot tub for several weeks. Driving is also restricted immediately after the procedure, often for up to four weeks.
Medical Procedures That Must Be Avoided
The most complex restriction involves diagnostic imaging, particularly Magnetic Resonance Imaging (MRI). An MRI machine generates a powerful magnetic field and radiofrequency pulses that can interact with the metallic components of the SCS. For older or non-compatible systems, this interaction can damage the internal electronics, cause severe tissue burns from heating at the lead tip, or induce current that may shock the patient.
Modern SCS technology includes “MRI-Conditional” systems, but these still require careful management. The device must be programmed into an MRI-safe mode. Furthermore, the scan may be limited to certain body regions or specific types of MRI machines, such as 1.5 Tesla scanners. Patients must always notify their healthcare provider and the imaging technician about the presence of the stimulator before any scan.
Another forbidden procedure is Diathermy, which uses high-frequency electrical currents to create therapeutic heat within body tissues. The energy from diathermy transfers through the implanted system, causing severe tissue damage at the electrode site, even if the stimulator is turned off. Specific types of therapeutic radiation, such as those used in cancer treatment, are also contraindicated unless the radiation beam can be precisely aimed to avoid the stimulator’s components entirely.
Environmental and Technological Limitations
Patients must be mindful of environmental factors that generate strong electromagnetic fields. Strong magnets, such as those found in large industrial motors, powerful stereo speakers, or heavy machinery, can interfere with the SCS. This interference may cause the device to turn on or off unintentionally. While common household electronics like microwaves and cell phones are safe, manufacturers advise keeping mobile phones and smart watches at least six inches away from the implanted pulse generator.
Security systems also require careful navigation. Walking through airport metal detectors or full-body scanners can temporarily increase the stimulation intensity, which may be startling. To avoid unnecessary interaction, patients should carry their SCS identification card and request a manual pat-down or wand screening instead of walking through the archway. The handheld patient programmer or remote control for the SCS should also not be placed directly over the implant site when not in use.
Activities That Risk Device or Lead Damage
Beyond the initial recovery, lifestyle modifications are necessary to protect the implanted system from physical trauma. Activities involving high-impact or aggressive contact, such as football, rugby, or intense martial arts, must be avoided permanently. These jarring movements put excessive stress on the system, risking damage to the implantable pulse generator (IPG) or causing the leads to shift from their optimal position near the spine.
Chronic heavy lifting should be limited, as it strains the muscles and tissues surrounding the leads, increasing the chance of migration or breakage. Activities causing sudden, repetitive, or extreme spinal movement, such as vigorous twisting or repeated deep bending, can also compromise lead placement. Furthermore, patients should avoid scuba diving deeper than 10 meters (about 33 feet) or entering a hyperbaric chamber due to significant pressure changes that can damage the device.