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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 leads","scope":"procedure","source":{"url":"https://www.cuh.nhs.uk/patient-information/spinal-cord-stimulation-scs-frequently-asked-questions-faq/","host":"cuh.nhs.uk","quote":"X-ray guidance is used to ensure accurate positioning.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C4","text":"Ask where the battery will be placed and when this will be discussed with you","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 most suitable position will be discussed with you in clinic.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C5","text":"Ask the surgeon about the risks of fitting the stimulator before you book","scope":"procedure","source":{"url":"https://www.dgft.nhs.uk/pil/spinal-cord-stimulation/","host":"dgft.nhs.uk","quote":"As with any surgical procedure, the insertion of a spinal cord stimulator has 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 concerns.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"F2","text":"Forceful persuasion or cheap, time-limited offers pushing you into a quick decision","scope":"treatment_abroad","source":{"url":"https://travelaware.campaign.gov.uk/surgery-abroad-cut-out-the-risk/","host":"travelaware.campaign.gov.uk","quote":"Don’t be pressured into quick decisions either through forceful persuasion or cheap, time limited offers.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"F3","text":"A price that sounds too good to be true probably is","scope":"treatment_abroad","source":{"url":"https://www.plasticsurgery.org/news/articles/will-economic-uncertainty-drive-more-patients-overseas-for-plastic-surgery-what-to-consider-and-how-to-stretch-your-dollar-back-home","host":"plasticsurgery.org","quote":"If the price sounds too good to be true, it probably 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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summary","source":{"url":"https://sbuhb.nhs.wales/about-us/individual-patient-commissioning/ipc-folder/advice-on-accessing-treatment-abroad","host":"sbuhb.nhs.wales","quote":"When you have treatment abroad, you must ask the treatment provider for their follow-up recommendations documented within a written discharge summary in English.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"alternatives":{"status":"ok","items":[{"id":"A1","text":"Your pain has not yet been treated with nonsurgical options","name":"Physical therapy","source":{"url":"https://my.clevelandclinic.org/health/treatments/24237-spinal-cord-stimulator-scs","host":"my.clevelandclinic.org","quote":"Your healthcare provider will usually suggest other, nonsurgical treatments, like physical therapy and medications, before a spinal cord 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