Spinal Cord Stimulator Review: Disadvantages And Risks Of The Surgery Implant

Depending on the location of the pain, the stimulator may be implanted along the cervical (neck) or lumbar (lower back) region of the spine. The pulse generator is placed under the skin near the abdomen or buttocks. The implantation process occurs in two phases: a trial period in which temporary leads are placed to evaluate whether the device provides at least 50% pain relief, followed by permanent implantation if the trial is considered successful.

The original form of the technology, this device delivers low-frequency electrical stimulation to the dorsal columns of the spinal cord. It uses a non-rechargeable battery that must be surgically replaced when depleted, typically every two to five years. This design requires repeat surgeries simply to maintain battery function. 

A newer iteration that uses a rechargeable battery, reducing the frequency of battery replacement surgeries. The device still requires the patient to charge it externally on a regular basis, which can be inconvenient and, for some patients, difficult to manage consistently.

A variation that delivers electrical impulses through percutaneous leads without requiring a permanent implant in some configurations. This design offers some flexibility in lead placement but carries its own set of procedural risks and limitations.

The efficacy data for spinal cord stimulators are inconsistent and heavily influenced by the populations studied and the criteria used to define success.

A 2024 systematic review and network meta-analysis published in JAMA Network Open evaluated SCS therapies compared to conventional medical management for chronic back and leg pain across several diagnoses including failed back surgery syndrome, complex regional pain syndrome, and diabetic peripheral neuropathy. While the analysis found some advantages for SCS over medical management in certain patient populations, it also highlighted significant variability in outcomes and the importance of careful patient selection. ²

A real-world study of 505 patients who underwent SCS trials between 2022 and 2024, published in PMC, found that 86.1% of patients achieved trial success, defined as at least 50% pain relief at the time of lead removal. However, at follow-up ranging from 3 to 34 months, only 76.6% of permanently implanted patients maintained significant improvement. The same study documented a 14.1% explantation rate (Surgical removal rate), with loss of efficacy as the most common reason for removal. ³

A separate retrospective study found that clinically significant pain relief from spinal cord stimulation ranges from just 16% to 85% depending on the patient population and study methodology, a range so wide it makes predicting individual outcomes nearly impossible. ⁴

Perhaps most concerning, a large real-world study published in JAMA Neurology in 2023 found no association between spinal cord stimulation and reduced opioid use at two years and noted increased overall costs and common complications among SCS patients compared to those receiving conventional medical therapy. ⁵ This directly challenges one of the most frequently cited rationales for SCS adoption.

A 22-year retrospective study published in Pain Physician in 2024, covering 519 patients across two cohorts at a single institution, documented the full range of biological complications associated with SCS implantation. These include allergic and foreign-body reactions, dural puncture and cerebrospinal fluid leaks, surgical site infections, poor wound healing, skin erosions, neurological injuries, and subcutaneous or epidural hematomas. ⁶ In a five-year single-institution study, the biological complication rate was 11.8%. ⁷

The same 22-year study documented device complications including electrical leaks, inadequate pain coverage, lead fractures, lead migration, ligamentum flavum stimulation, battery failures, and unwanted stimulation. The device complication rate in the five-year institutional study was 14.9%. Complication rates across the broader literature range from 21% to 63%. ⁸ 

Lead migration, in which the stimulator leads shift from their intended position, is one of the most common and challenging complications. When leads migrate, the electrical stimulation no longer covers the area responsible for the patient's pain, and therapeutic benefit is lost. Correcting lead migration requires a return to the operating room.

One of the most significant problems with spinal cord stimulators is that their effectiveness tends to diminish over time. A retrospective study documented that pain scores increased by nearly 2 points on the visual analog scale within two years of implantation, reflecting a measurable decline in the device's effectiveness as the body and nervous system adapt to the electrical stimulation. ³ Up to 29% of patients report loss of efficacy over time requiring reprogramming or surgical revision. ⁹

A 2025 retrospective cohort study from Saint Louis University published in Neurology International identified failure rates of up to 44% for spinal cord stimulators and annual explantation rates of 6 to 9%, creating a clear need to better identify patients at high risk for therapeutic failure before implantation. ¹⁰ In the 505-patient real-world outcomes study, the overall explantation rate was 14.1%. 

A retrospective study published in Global Spine Journal examining 1,014 index SCS procedures over a 10-year period found that 175 reoperations were performed within the study window, a reoperation rate of approximately 17%. The authors noted that accurate lead positioning and design improvements to generators could reduce this rate but acknowledged that significant reoperation burden remains a real feature of SCS management. ⁴

Beyond specific complications, spinal cord stimulators carry a number of practical disadvantages that patients should understand before proceeding: 

Cost: SCS systems are expensive, often ranging from $15,000 to over $50,000 for the device alone, plus surgical and facility fees. Insurance coverage is variable and often requires extensive prior authorization. 

MRI restrictions: While some newer models are conditionally MRI-compatible, many SCS systems restrict or prohibit MRI scanning, which limits the ability to evaluate the spine and other body structures if new problems arise. 

Airport security: SCS devices can trigger security screening equipment. Patients are typically provided an identification card to facilitate airport screening, but some experience uncomfortable device interference near security systems. 

Activity restrictions: Patients with SCS systems must power off their device before driving or operating heavy machinery. 

Battery replacement surgery: Non-rechargeable systems require repeat surgeries for battery replacement, typically every two to five years. 

Device may need full replacement: If the device fails, becomes infected, or loses efficacy, full explantation surgery is required, adding to cumulative surgical risk and cost. 

Rare but severe adverse events have been reported with SCS implantation, including cases of spinal cord injury resulting from device placement or lead migration, implant site infections requiring device removal and prolonged antibiotic treatment, and, in isolated cases, device failures causing dangerous electrical events. ¹¹ While serious adverse events are uncommon, they underscore the importance of weighing the full risk profile before proceeding with implantation.

For many patients, particularly those with early-stage disc conditions or muscular pain, conservative treatments remain the most appropriate first line of care. These include physical therapy, anti-inflammatory medications, epidural steroid injections, chiropractic care, acupuncture, massage therapy, and structured exercise programs. The key distinction from SCS is that these approaches carry no surgical risk and no permanent device-related complications.

For patients with chronic back or neck pain caused by herniated discs, bulging discs, annular tears, sciatica, spinal stenosis, or pinched nerves, Deuk Laser Disc Repair (DLDR) is the most advanced, evidence-based, curative surgical option available. 

What it is: Deuk Laser Disc Repair is a minimally invasive, motion-preserving procedure developed by Dr. Ara Deukmedjian, a board-certified neurosurgeon at Deuk Spine Institute. It is performed entirely endoscopically through a 4 to 7 mm incision, smaller than a pencil eraser. There is no bone removal, no muscle cutting, no hardware implantation, and no fusion. 

How it works: Using live imaging, the surgeon guides a small tube into the damaged disc. A high-definition endoscopic camera and a precision Holmium:YAG laser are inserted through the tube. The laser removes only the damaged 5 to 10% of the disc tissue causing herniation and inflammation, leaving healthy disc structure completely intact. It also treats the annular tear, the actual source of discogenic pain that spinal cord stimulators do nothing to address. The entire procedure takes approximately one hour. 

Why it is different from a spinal cord stimulator: A spinal cord stimulator leaves the damaged disc in place and attempts to mask the pain signal. Deuk Laser Disc Repair removes the tissue causing the pain. One treats the symptom; the other treats the cause. 

Proven results: Over more than 20 years and more than 2,000 procedures, Deuk Laser Disc Repair has achieved a 99.6% success rate in eliminating back and neck pain caused by disc damage, with zero complications on record. Most patients walk out of the surgical center within an hour and return to daily activities within days. 

No opioids required: Unlike many traditional spine procedures, Deuk Laser Disc Repair does not require narcotic pain medication during recovery. 

Conditions treated: 

• Herniated and bulging discs (cervical and lumbar) 
• Degenerative disc disease 
• Annular tears 
• Sciatica and radiculopathy 
• Spinal stenosis (disc-related) 
• Chronic back and neck pain 
• Pinched nerves 

If you have a herniated or bulging disc or chronic disc-related back or neck pain, submit your MRI for a free review at Deuk Spine Institute to learn whether you are a candidate

No. A spinal cord stimulator is not a cure for chronic back or neck pain. It is a pain management device that works by intercepting pain signals before they reach the brain. It does not repair herniated discs, seal annular tears, decompress pinched nerves, or correct any structural pathology. The published evidence shows that efficacy tends to decline over time in a meaningful percentage of patients, with one study documenting increasing pain scores within two years of implantation. Explantation rates of 6 to 9% annually and overall failure rates of up to 44% have been reported in peer-reviewed research. For patients with disc-related pain, a curative procedure that addresses the structural source of pain is a more appropriate long-term solution. 

The most frequently documented complications fall into two categories: biological and device-related. Biological complications include surgical site infections, dural puncture and cerebrospinal fluid leaks, hematomas, poor wound healing, skin erosions, and in rare cases neurological injury. Device complications include lead migration (the most common device complication), lead fractures, battery failures, electrical leaks, and loss of therapeutic effect. Published complication rates range from 11.8% for biological complications and 14.9% for device complications in one institutional study, to overall rates of 21% to 63% in the broader literature. Reoperation for lead revision or device failure adds further surgical risk over time.

The two approaches represent fundamentally different philosophies. A spinal cord stimulator masks pain signals without touching the structural source of the problem. Deuk Laser Disc Repair removes the damaged disc tissue and treats the annular tear that is causing the pain, resolving the problem at its origin. DLDR uses a 4 to 7 mm incision with no bone removal, no hardware, and no fusion. Recovery takes days rather than months. The procedure has a 99.6% success rate across more than 2,000 cases with zero complications. There are no long-term device maintenance requirements, no battery replacement surgeries, no MRI restrictions, and no diminishing returns as the nervous system adapts to electrical stimulation over time. For patients with disc-related chronic back or neck pain who are being offered a spinal cord stimulator, an evaluation for DLDR candidacy is strongly recommended before proceeding with implantation.

Yes, the device can be surgically removed. However, explantation is itself a surgical procedure with associated risks including infection, bleeding, and nerve injury. The cost of removal is typically not covered by the device manufacturer, and insurance coverage for explantation varies. A 2025 study found that the leading reasons for explantation are loss of efficacy and lead migration, meaning many patients who undergo permanent implantation still end up having the device removed later. Before committing to permanent implantation, it is essential to thoroughly understand the full risk profile of both the initial procedure and the potential need for removal, and to have genuinely evaluated all available alternatives.