Who Can Go For Spinal Cord Stimulation?

Spinal cord stimulation is a neuromodulation option for chronic, severe neuropathic pain that has stopped responding to medication, physiotherapy, or nerve blocks. The strongest results show up in patients with Failed Back Surgery Syndrome, Complex Regional Pain Syndrome, and persistent radicular nerve pain in the back, neck, arms, or legs. The clinical premise is straightforward. A small implanted device sends low-voltage impulses into the dorsal columns of the spinal cord and disrupts the abnormal pain signalling before it reaches the brain. Candidacy depends on six things, pain duration beyond six months, neuropathic origin, failure of conservative care, no active infection, psychiatric stability, and a successful trial-phase response of 50% pain reduction or more. The procedure runs in two stages, a 7 to 10-day trial implant first, followed by permanent implantation only if the trial actually works.

According to Dr. Gurneet Singh Sawhney, a senior neurosurgeon in Mumbai, Spinal cord stimulation works best when the patient is selected carefully and the trial response is honest. The therapy is fully programmable and fully reversible, which means it can adapt to how the pain evolves, but the candidacy workup is what really decides the long-term outcome.

Standard pain management approaches work on the surface of that problem. SCS works closer to the source.

The device sends low-voltage electrical impulses into the dorsal columns of the spinal cord. Those impulses interrupt the abnormal signal traffic and reduce what the brain receives as pain. It’s used for neck, back, lower limb, and upper limb pain that hasn’t responded to other approaches.

Nothing is permanent at this stage. Dr. Gurneet Singh Sawhney, an experienced spine surgeon in Mumbai, runs a 7 to 10-day trial first. The stimulator goes in temporarily. How the patient responds over that window determines whether permanent implantation makes clinical sense.

The patient lies face down. Trial leads go into the epidural space through a hollow needle, guided by live fluoroscopic imaging. Local anaesthesia with sedation keeps the patient comfortable. The leads are positioned to cover the exact pain area.

Once in place, the leads connect to an external pulse generator the patient wears. The clinical team tracks pain levels, functional changes, and patient feedback across the trial period. If pain drops by 50% or more, that’s the threshold for moving forward.

When the trial works, the surgeon moves to permanent placement. The leads go back into the epidural space and are tunnelled under the skin toward the pulse generator.

A small pocket, usually in the upper buttock or lower abdomen, houses the generator. It connects to the leads, the incisions close, and the patient leaves with a fully functioning device they control directly.

The stimulation settings can be adjusted at any follow-up. The device can also be removed entirely if circumstances change. Nothing about this is irreversible.

Pain that’s been present for more than six months, hasn’t responded to conservative treatment, and isn’t tied to movement is where SCS candidacy typically starts. The conditions below are the ones most consistently considered:

Not everyone qualifies. Some conditions make SCS unsuitable regardless of pain severity:

Results depend heavily on how well the patient was selected and how precisely the leads were placed. That’s not a caveat, it’s the actual clinical reality of how SCS works.

In patients with FBSS and CRPS, published follow-up data shows more than 50% pain reduction past the two-year mark in a significant proportion of cases. Opioid use tends to drop. Sleep improves. Daily function comes back in stages.

One thing that makes SCS different from most fixed interventions is that the device is programmable. Frequency, pulse width, amplitude, all of it can be adjusted without surgery at any follow-up visit. As a patient’s pain pattern shifts over time, the therapy can shift with it. That’s a meaningful clinical advantage over procedures where what’s done is done.

Most patients return to light daily activity within four to six weeks of permanent implantation. More demanding physical activity is assessed case by case. Follow-up attendance and device management are what separate patients with durable outcomes from those who plateau early.

Dr. Gurneet Singh Sawhney is a senior consultant neurosurgeon at Fortis Hospital Mulund with over 15 years of experience in functional neurosurgery, neuromodulation, and complex spine surgery. His clinical work includes spinal cord stimulator implantation, deep brain stimulation, and minimally invasive procedures for treatment-resistant chronic pain.

Patients with Failed Back Surgery Syndrome, CRPS, and persistent radicular pain come to him after years of failed medication and conservative care. The clinic handles candidacy evaluation, trial-phase implantation, permanent placement, and long-term device reprogramming under one roof.

Reference:

• Spinal Cord Stimulation for Chronic Pain – National Institute of Neurological Disorders and Stroke, NIH
• Neuromodulation Therapy and Patient Selection Criteria – International Neuromodulation Society

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