What Is a Spinal Cord Stimulator?

A Spinal Cord Stimulator (SCS) is a small medical device that delivers mild electrical pulses to the spinal cord. These pulses help reduce or block pain signals before they reach the brain. It is a type of neuromodulation — a method that changes how the nervous system sends signals.

In children, SCS is used when other treatments such as medicines, physical therapy, or surgeries have not given enough relief from chronic (long-lasting) pain or certain movement problems. It is not a cure, but it helps manage the condition so that daily life becomes easier.

SCS was originally developed for adults, but its use in children has grown over the past two decades as technology has improved and medical evidence has become stronger. Pediatric use requires careful evaluation, and the decision is always made by a specialized medical team.

Purpose of the Device and Where It Is Used

The main purpose of a spinal cord stimulator is to reduce chronic pain that has not responded to standard treatments. In children, it is also used in certain neurological and movement conditions.

Conditions Where SCS May Be Used in Children

Who May Be Considered for SCS?

• Children with chronic pain lasting more than 3 to 6 months
• Those who have not improved with medications, physical therapy, or other treatments
• Children who are psychologically screened and found suitable
• Children who are old enough to understand and cooperate with the procedure (generally above 8 to 10 years, though younger cases have been reported)
• Those without active infections, bleeding disorders, or certain other medical conditions

Types of Spinal Cord Stimulators

There are several types of SCS systems available. They differ in the technology they use and how the pulse generator is powered.

Components of an SCS System

How Does a Spinal Cord Stimulator Work?

The spinal cord carries pain signals from different parts of the body up to the brain. The SCS device interrupts or modifies these signals before they reach the brain, so the brain perceives less pain.

The leads (electrodes) are placed in the epidural space — the area just outside the covering of the spinal cord. When the device is on, it sends gentle electrical impulses to the nerves. Depending on the type of SCS used, this may create a tingling feeling, or it may work without any feeling at all.

The Trial and Implantation Process

SCS is always done in two stages — a trial first, and then a permanent implant if the trial is successful. This is especially important in children.

Stage 1 — The Trial Phase

• Temporary leads are placed near the spinal cord under imaging guidance (X-ray or fluoroscopy)
• The external end of the lead is connected to a small external pulse generator worn outside the body
• The trial lasts about 5 to 10 days
• Pain levels and daily activities are recorded during this period
• A successful trial = at least 50% reduction in pain (some guidelines say 30-50% in children)
• If the trial fails, the temporary leads are removed, and no permanent device is implanted

Stage 2 — Permanent Implantation

If the trial is successful, a permanent system is implanted in a surgical procedure under general anesthesia. The leads are secured near the spine, and the pulse generator is placed under the skin — usually near the lower back, buttock, or abdomen.

How to Use a Spinal Cord Stimulator - Step by Step

After the device is implanted and programmed by the medical team, here is how it is typically managed on a day-to-day basis.

Daily Use - Step by Step

1. 1
   Turn the Device OnUsing the external remote control (patient controller), press the power button to turn the stimulator on. The device may also be set to turn on automatically by the medical team.
2. 2
   Select the Right ProgramThe medical team pre-sets programs in the device. Each program is for different activities (rest, walking, sleeping). Choose the correct program using the remote control as instructed.
3. 3
   Adjust the Stimulation IntensityUse the up and down buttons on the remote to increase or decrease the intensity of the electrical pulses within the allowed range set by the medical team. Do not exceed the maximum limit.
4. 4
   Check the Battery LevelCheck the remote control screen for the device battery level. For rechargeable systems, charge the IPG regularly as directed (usually every 1 to 2 days for about 30 to 60 minutes) using the wireless charging pad.
5. 5
   Charge the Device (Rechargeable Systems Only)Place the charging pad over the area of skin where the pulse generator is implanted. A signal (light or sound) confirms charging is active. Sit quietly during charging — the child does not need to stop all activity.
6. 6
   Turn the Device Off When InstructedSome children turn off the device at night or in certain settings. Follow the medical team's specific guidance on when to turn it off.
7. 7
   Keep a Daily Pain and Activity LogRecord pain scores (0 to 10) every day, along with activities done and any problems noticed. This helps the medical team adjust settings during follow-up visits.
8. 8
   Attend All Follow-Up AppointmentsThe device must be regularly checked and re-programmed by the neurosurgeon or pain specialist. In children, visits are usually more frequent because of growth-related changes.

Precautions and Potential Risks

General Precautions

• Always carry the device identification card provided at the time of implantation
• Inform all doctors, dentists, and other healthcare providers that an SCS is in place before any procedure
• Avoid MRI scans unless specifically confirmed by the medical team as MRI-safe (most modern SCS devices have conditional MRI safety — this must be verified for each device)
• Inform airport or security staff about the implanted device — it may trigger security alarms
• Keep the remote control and charging device away from other electronics with strong magnetic fields
• Do not allow others to adjust the device settings
• Avoid contact sports or activities that risk a direct impact on the implant site, unless cleared by the surgical team

Activities to Discuss with the Medical Team

Possible Risks and Complications

How to Keep the Device Safe

• Keep the external remote control in a clean, dry place. Do not drop or submerge it in water.
• Charge the charging pad and remote regularly as instructed — do not wait until the battery is fully empty.
• Store all accessories away from extreme heat, cold, or strong magnets (e.g., do not place near large speakers, induction cooktops, or industrial equipment).
• Do not attempt to repair or modify any part of the device. Always contact the manufacturer's helpline or the medical team for device problems.
• Keep the device ID card safe and carry it always. A duplicate should be kept at home.
• Inform the school nurse or school staff about the device and what to do if the child reports sudden changes in stimulation or discomfort.
• Do not allow magnets, phones, or tablets near the implant site for extended periods unless cleared by the medical team. Most modern smartphones can be kept in a trouser or shirt pocket on the opposite side of the body from the IPG.
• Follow the manufacturer's specific care guide provided with the device — guidelines may vary between brands.

Wound and Skin Care After Implantation

• Keep the surgical wound clean and dry until it is fully healed (usually 4 to 6 weeks)
• Do not scratch, press, or try to feel the device under the skin
• Report any skin changes over the implant area (redness, swelling, skin thinning, or wound opening) immediately
• Do not apply creams, heat packs, or cold packs directly over the implant site without medical advice

SCS and Children's Growth

Children's bodies grow significantly over time. This is one of the most important differences between SCS in children and adults. The following points are specific to the pediatric use of SCS.

• Lead migration is more common in children due to rapid growth — regular follow-up is essential
• The surgical team leaves extra lead length (slack) during implantation to account for future growth
• The pulse generator size is chosen based on the child's body size and may need replacement as the child grows
• Programming may need frequent adjustments as the spine grows and lead position changes
• Rechargeable systems are preferred to avoid repeated battery replacement surgeries during childhood
• Psychological support and school reintegration support are important parts of the overall treatment plan

Frequently Asked Questions

Psychological Support and Quality of Life

Chronic pain in children affects not just the body, but also mental health, school attendance, social life, and family wellbeing. SCS is most effective when it is part of a complete care plan that includes:

• Psychological evaluation before and after SCS implantation
• Cognitive-behavioral therapy (CBT) or pain psychology sessions
• School reintegration plans and support from educational staff
• Family counseling and education about the condition and device
• Regular physical and occupational therapy alongside SCS use
• Peer support and social reintegration

Recommended Resources

The information on this page is based on published medical literature and international clinical guidelines. For further reading, the following official sources are recommended:

• North American Neuromodulation Society (NANS) - www.neuromodulation.org
• International Neuromodulation Society (INS) - www.neuromodulation.com
• World Health Organization (WHO) - Pediatric Pain Guidelines
• American Academy of Pediatrics (AAP) - Pain Management in Children
• British Pain Society - Guidelines on Spinal Cord Stimulation
• IASP (International Association for the Study of Pain) - www.iasp-pain.org
• Textbook: "Pediatric Pain Management" - Edited by Suresh S, Wheeler M, Patel A (Springer)
• Textbook: "Essentials of Pain Medicine" - Benzon HT et al. (Elsevier)
• PubMed Central - Search "Spinal Cord Stimulation Pediatric" for peer-reviewed studies (www.ncbi.nlm.nih.gov/pmc)
• Device-specific manuals provided by manufacturers such as Medtronic, Abbott (St. Jude Medical), and Boston Scientific