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Desk work often possible after about 2 weeks; physical work takes longer."},"complication_rate_pct":{"min":15,"max":35,"unit":"percent","qualifier":"Any device-related complication (lead migration, infection, pain at pocket, hardware issues) within 1-2 years; serious ones under 5%."},"contraindications":["Active systemic or local infection at the planned implant site","Uncorrected bleeding disorder or unmanageable therapeutic anticoagulation","Failed trial stimulation (insufficient pain relief)","Untreated significant psychological conditions or substance use disorder","Pregnancy (relative, case-dependent)","Anatomy preventing safe lead placement, e.g., severe spinal stenosis (relative)"],"days_in_clinic":{"min":0,"max":1,"unit":"nights","qualifier":"Per procedure (trial or permanent percutaneous implant); usually same-day discharge, with an occasional overnight observation stay."},"diagnostic_duration_minutes":null,"diagnostic_preparation":null,"diagnostic_referral_needed":null,"diagnostic_result_time_hours":null,"exercise_resume_weeks":{"min":6,"max":12,"unit":"weeks","qualifier":"From permanent implant; avoid strenuous activity, bending, twisting and heavy lifting while leads anchor. Light walking earlier."},"final_result_months":{"min":2,"max":4,"unit":"months","qualifier":"From permanent implant; reflects healing, lead anchoring and programming optimization. Stimulation settings may keep adjusting."},"fly_home_after_days":{"min":7,"max":14,"unit":"days","qualifier":"After permanent implant, depending on wound check and surgeon clearance; avoid strain and carry device ID card."},"follow_up_visits":[{"purpose":"result_review","requirement":"routine","after":{"min":5,"max":14,"unit":"days","qualifier":"After trial lead placement (day 0); assessment of pain relief to decide on permanent implant."}},{"purpose":"wound_check","requirement":"routine","after":{"min":14,"max":56,"unit":"days","qualifier":"14-56 days from trial day 0; about 7-14 days after permanent implant, which follows trial by 7-42 days."}},{"purpose":"assessment","requirement":"routine","after":{"min":21,"max":84,"unit":"days","qualifier":"21-84 days from trial day 0; programming review about 2-6 weeks after permanent implant."}}],"indications":["Refractory neuropathic back/leg pain, including failed back surgery syndrome","Complex regional pain syndrome","Painful diabetic peripheral neuropathy","Refractory angina pectoris","Chronic limb ischemic pain"],"main_risks":["Infection of the device pocket or leads","Lead migration or fracture with loss of pain coverage","Epidural hematoma or bleeding","Dural puncture with headache or cerebrospinal fluid leak","Nerve or spinal cord injury (rare)","Pain at the generator pocket or seroma","Hardware malfunction, battery depletion or need for revision/explant","Uncomfortable stimulation sensations"],"pain":"Procedure is done under local anesthesia with sedation. Moderate incision-site and back pain is expected for the first 1-2 weeks, managed with oral analgesics.","preparation":["Specialist pain assessment, imaging review and psychological screening","Successful trial stimulation before permanent implant","Review of medications and blood-thinning treatment by the surgical team","Infection screening and skin preparation","Fasting as instructed for sedation","Discussion of MRI compatibility and device-driving/activity limitations","Arrange for an adult to accompany the patient home"],"recovery_timeline":[{"phase":"Trial phase (about 5-14 days)","description":"Temporary percutaneous leads connected to an external stimulator to test pain relief.","restrictions":["Keep dressing dry","Avoid excessive bending, twisting and lifting","Avoid driving while stimulation is on, as advised"]},{"phase":"First 2 weeks after permanent implant","description":"Incision healing; discharge usually same day.","restrictions":["Avoid lifting heavy objects","Avoid bending and twisting","Keep wounds dry until cleared"]},{"phase":"Weeks 2-6","description":"Gradual return to light work and daily activities; programming optimization begins.","restrictions":["Continue lifting, bending and twisting limits"]},{"phase":"Weeks 6-12","description":"Lead anchoring stabilizes; progressive return to exercise as cleared by the surgeon.","restrictions":["Increase activity gradually"]}],"rehabilitation_days":{"min":28,"max":42,"unit":"days","qualifier":"Ordinary functional recovery after permanent percutaneous implant, with gradual return to daily activity; full activity restrictions last longer."},"result_longevity":"Depends on the device type: non-rechargeable batteries typically last a few years and rechargeable systems often longer before generator replacement. Pain relief may decline over time in some patients.","revision_rate_pct":{"min":10,"max":25,"unit":"percent","qualifier":"Surgical revision, repositioning or explant within 2 years, mainly for lead migration, hardware issues or infection."},"scars":"Small incision(s) at the lead entry site in the midline lower back and a pocket incision for the generator (buttock, flank or abdomen), typically a few centimetres each.","sessions_or_stages":{"sessions":{"min":2,"max":2,"unit":"visits","qualifier":"Two procedures: trial lead placement and permanent implant."},"stages":[{"code":"trial_lead_placement","label":"Trial: temporary percutaneous lead placement and external stimulation test","after":{"min":0,"max":0,"unit":"days","qualifier":"Initial procedure (day 0)."}},{"code":"permanent_implant","label":"Permanent percutaneous lead and implantable pulse generator placement after successful trial","after":{"min":7,"max":42,"unit":"days","qualifier":"From trial lead placement, after the trial period and review."}}],"qualifier":"Standard two-stage course (trial then permanent) with percutaneous leads; some centres implant permanent leads for the trial."},"success":{"metric":"Patients with at least 50% pain relief","value":50,"unit":"percent of implanted patients","horizon":"12 months after permanent implant","population":"Adults with chronic neuropathic back and leg pain and a successful trial","evidence_status":"limited"},"techniques":[{"name":"Percutaneous lead implantation with implantable pulse generator (primary approach)","suits_whom":"Most patients with a successful trial.","recovery":"Same-day discharge typical; return to light work in about 2-6 weeks."},{"name":"Surgical paddle-lead implantation (laminotomy)","suits_whom":"Patients with lead migration, failed percutaneous coverage or anatomy needing a paddle lead.","recovery":"Usually under general anesthesia; longer recovery, possible overnight stay."}],"treatment_conditions":["day_case"],"treatment_duration_hours":{"min":1,"max":2.5,"unit":"hours","qualifier":"For the permanent percutaneous lead and generator implantation procedure only; the trial lead placement is usually shorter."},"initial_assessment_documents":["Lumbar or cervical spine MRI report and images","Pain diagnosis and duration summary","Previous spine surgery operative reports","Pain treatments tried and outcomes","List of blood thinners"],"travel_trips":{"min":1,"max":2,"one_trip_possible":true,"qualifier":"Trial and implant 1-6 weeks apart; one trip needs 2-3 weeks' stay. Follow-up checks can be local."},"clinic_checks":{"status":"ok","items":[{"id":"C1","text":"Ask whether a trial of stimulation is done before the full system is implanted","scope":"procedure","source":{"url":"https://www.cuh.nhs.uk/patient-information/spinal-cord-stimulator-implant/","host":"cuh.nhs.uk","quote":"Following your successful trial of spinal cord stimulator (SCS) therapy you have now had the full system implanted.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C2","text":"Ask whether a pain specialist and a spinal surgeon will both be involved in your care","scope":"procedure","source":{"url":"https://www.cuh.nhs.uk/patient-information/spinal-cord-stimulation-scs-frequently-asked-questions-faq/","host":"cuh.nhs.uk","quote":"The procedure may involve both a pain specialist and a spinal surgeon.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C3","text":"Ask whether X-ray guidance will be used to position the 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some risks.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C6","text":"Confirm that follow-up appointments are arranged after implantation","scope":"procedure","source":{"url":"https://www.cuh.nhs.uk/patient-information/spinal-cord-stimulator-scs-single-stage-implant-going-home/","host":"cuh.nhs.uk","quote":"When you and the team are happy, you will be able to go home with follow-up appointment(s) arranged.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"red_flags":{"status":"ok","items":[{"id":"F1","text":"An advert or information that guarantees complete success should raise concerns","scope":"treatment_abroad","source":{"url":"https://travelaware.campaign.gov.uk/surgery-abroad-cut-out-the-risk/","host":"travelaware.campaign.gov.uk","quote":"Any advert or information that guarantees complete success should raise 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is.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"warning_signs":{"status":"missing","reason":"no_official_source","checked_at":"2026-11-13","next_check_at":"2027-02-11"},"take_home":{"status":"ok","items":[{"id":"T1","text":"Carry it at all times so staff know about the implant","document":"implant identification card","source":{"url":"https://www.cuh.nhs.uk/patient-information/spinal-cord-stimulation-scs-frequently-asked-questions-faq/","host":"cuh.nhs.uk","quote":"You should carry this with you at all times, especially when travelling.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"T2","text":"Lists warning signs and actions to take after the implant","document":"going-home information leaflet","source":{"url":"https://www.cuh.nhs.uk/patient-information/spinal-cord-stimulator-scs-single-stage-implant-going-home/","host":"cuh.nhs.uk","quote":"The information below tells you what to avoid, what to look out for and what action to take if you think that you have any problems.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"T3","text":"Sets out safe activities and exercises during recovery after the implant","document":"physical activity advice leaflet","source":{"url":"https://www.cuh.nhs.uk/patient-information/cuh-spinal-cord-stimulator-scs-cervical-spine-physical-activity-advice/","host":"cuh.nhs.uk","quote":"The leaflet explains what activities are safe for you to do following your implant what to avoid while the wounds heal and which physiotherapy exercises can support your recovery.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"T4","text":"Shows the scheduled review that the home doctor can follow up","document":"follow-up appointment 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