Is a spinal cord stimulator considered a permanent implant?

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Last updated: October 15, 2026 • View editorial policy

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Is a Spinal Cord Stimulator a Permanent Implant?

A spinal cord stimulator is considered a permanent implant once the full system (including the implantable pulse generator/IPG) is placed, though it can be removed if needed and typically requires a trial period before permanent implantation.

Understanding the Two-Stage Process

The standard approach to SCS involves a mandatory trial phase before permanent implantation 1. This is not merely a recommendation but a fundamental requirement in clinical practice:

  • Trial Phase: A temporary lead is placed (typically percutaneously) to assess therapeutic efficacy before committing to permanent hardware
  • Permanent Phase: If the trial is successful (typically defined as ≥50% pain relief), the patient proceeds to permanent implantation with an internalized pulse generator

1 explicitly states: "A spinal cord stimulation trial should be performed before considering permanent implantation of a stimulation device."

What Makes It "Permanent"

Once implanted, the SCS system includes:

  • Electrode leads placed in the epidural space (either percutaneous cylindrical leads or paddle leads via laminotomy)
  • Implantable pulse generator (IPG) placed subcutaneously, typically in the buttock or abdomen
  • Extension cables connecting the leads to the IPG

The system is designed for long-term, indefinite use with the IPG battery lasting several years before requiring replacement. Recent data shows that 76.6% of implanted patients maintain significant improvement over follow-up periods ranging from 3-34 months 2.

Important Caveats About "Permanence"

The Device Can Be Removed

Despite being called "permanent," SCS systems are not irreversible:

  • Explantation rate: 14.1% in recent real-world data 2
  • Common reasons for removal: Loss of efficacy, lead migration, infection, or increased pain from stimulation 3, 2
  • Risk factors for explantation: Tobacco use, depression, chronic opioid use, and post-implant falls 2

Alternative Approaches Exist

Recent literature describes variations on the traditional two-stage model:

"Permanent Trial" Technique 3:

  • Used in high-risk patients (3.54% of cases in one series)
  • Involves placing leads with tunneled extensions during trial
  • If successful, only the IPG is added without re-accessing the epidural space
  • Indications include: inability to hold anticoagulation, previous failed percutaneous trial, thoracic stenosis, or significant medical comorbidities
  • Shows 88.8% conversion to permanent implant (higher than traditional trials)

Direct-to-Implant (DTI) Strategy 4:

  • Emerging approach that bypasses the trial phase entirely
  • Reserved for carefully selected patients
  • Requires rigorous patient selection and intraoperative assessment
  • Reduces procedural burden, infection risk, and healthcare costs

Clinical Bottom Line

For practical purposes, once the full SCS system with IPG is implanted, it should be considered a permanent device that the patient will have indefinitely, though with the understanding that:

  • It can be surgically removed if complications arise or efficacy is lost
  • Battery replacement will be needed every several years
  • Approximately 1 in 7 patients may require explantation over time
  • The trial phase is temporary (typically 5-14 days) and does not constitute permanent implantation

The distinction matters for patient counseling, insurance authorization, and informed consent discussions about the commitment involved in SCS therapy.

References

3
Research

Permanent trials for spinal cord stimulation.

Pain practice : the official journal of World Institute of Pain, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.