The procedure for permanent implantation of a spinal cord stimulator is similar in many ways to the trial. The major difference is the implant of the generator. While the technology being used for spinal cord stimulation is rapidly changing, this is the typical process:

1. Local anesthesia is applied to the injection site. The patient can also be sedated.

2. The doctor inserts a hollow needle into epidural space, or the area around the spinal canal. This is guided by fluoroscopy (a type of X-ray). The needle contains thin, insulated wires called leads, with attached electrical contacts. A small incision may be needed required to insert the needle.

3. Part of the lamina, a small bone covering the back of the spinal cord, may be removed to allow more room to place the permanent leads.

4. The permanent leads are implanted. (In some cases, permanent leads can be used for the trial period and are not removed when the permanent SCS is placed.)

5. The doctor wakes up the patient to ensure the optimal placement of the electrodes for pain relief. When coverage of the areas of pain are complete, the leads are fixed in place. The patient is again sedated.

6. Then a small incision is made where the generator, or battery, will be placed.

7. This is planted under the skin -- in the abdomen, upper buttocks, or upper chest. Generators range in size. Currently the largest ones are about the size of a stopwatch. Comfort is a consideration in its location. The doctor and patient will discuss this prior to the procedure. Depending on the rechargeable generator, it can be left in the body for many years. However, the generator will probably need to be replaced at some point, requiring an additional surgical procedure.

8. Wires are then tunneled from the leads to the generator and connected. That enables the current to flow when the controller is on.

9. The incision is closed. The patient is sent to recovery.