Spinal Cord Stimulators

Advanced neuromodulation therapy for chronic, refractory spine and extremity pain — implanted under fluoroscopic guidance by Tzvi Grossman, MD when conservative and interventional treatments have been insufficient.

What Is Spinal Cord Stimulation?

Spinal cord stimulation (SCS) is an implantable neurotechnology that delivers low-level electrical pulses to the spinal cord, modulating pain signal transmission before it reaches the brain. For patients with chronic pain that has not responded adequately to medications, physical therapy, or prior interventional procedures, SCS offers a reversible, adjustable, and often transformative option.

Dr. Grossman performs SCS trial implantation and permanent lead placement under real-time fluoroscopic guidance, ensuring precise epidural electrode positioning at the target spinal level corresponding to the patient's pain distribution.

Conditions Treated

Failed back surgery syndrome (FBSS)
Complex regional pain syndrome (CRPS)
Chronic radiculopathy (cervical or lumbar)
Peripheral neuropathy
Refractory axial back or neck pain

The Two-Phase Approach

Trial phase: temporary lead placed 5–10 days to assess efficacy
Permanent implant: if ≥50% pain reduction during trial
Pulse generator implanted in gluteal or abdominal subcutaneous tissue
Fully adjustable via external programmer

Stimulation Modalities Available

Traditional tonic stimulation (paresthesia-based)
High-frequency stimulation (HF10 — paresthesia-free)
Burst stimulation protocols
Dorsal root ganglion (DRG) stimulation for focal pain

Candidacy Considerations

Chronic pain ≥6 months unresponsive to conservative care
No untreated structural surgical lesion
Psychological clearance completed
No contraindications to implant (pacemaker, infection, bleeding risk)

Procedure Details

SCS lead placement is performed under fluoroscopic guidance in the prone position, under local anesthesia with mild sedation. The percutaneous leads are advanced into the epidural space through an introducer needle and positioned at the target vertebral level under direct fluoroscopic visualization. Intraoperative testing confirms appropriate stimulation coverage of the painful region before leads are secured.

Fluoroscopic AP and lateral imaging throughout
Lead position confirmed in two planes before anchoring
Trial period: typically 5–7 days with external generator
Permanent implant: outpatient surgical procedure with subcutaneous IPG placement
Rechargeable and non-rechargeable IPG options available