Anesthetic Considerations and Perioperative
Management of Spinal Cord Stimulators:
Literature Review and Initial Recommendations
Authors: Harned Michael E. 
Published: January 2020

Background: Patients with implanted spinal cord stimulators (SCS) present to the anesthesia care team
for management at many different points along the care continuum. Currently, the literature is sparse on
the perioperative management. What is available is confusing; monopolar electrocautery is contraindicated
but often used, full body magnetic resonance imaging (MRI) is safe with particular systems but with
other manufactures only head and specific extremities exams are safe. Moreover, there are anesthetizing
locations outside of the operating room where implanted SCS can interact with surrounding medical
equipment and pose significant risk to patient and device.
Objectives: The objective of this review is to present relevant known literature about the safe
management of SCS in the perioperative period and to begin to develop recommendations.
Study Design: A review of current literature and each manufacturers’ labeling was performed to assess
risk of interference and patient harm between SCS and technology used in and around typical anesthetizing
locations.
Methods: A systematic search of the literature was conducted in accordance with the Preferred Reporting
Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. A computerized search was conducted for
English articles in print up to April 2016 via PubMed www.ncbi.nlm.nih.gov/pubmed; EMBASE www.embase.
com; and Cochrane Library www.thecochranelibrary.com. Search terms included “spinal cord stimulator AND
MRI,” “spinal cord stimulator AND ECG,” “spinal cord stimulator AND implanted cardiac device,” “spinal cord
stimulator AND electrocautery,” and “spinal cord stimulator AND obstetrics.” In addition, a search of Google
and Google Scholar was performed. Websites of SCS manufactures were reviewed.
Results: Generalized recommendations include turning the amplitude of the SCS to the lowest possible
setting and turning off prior to any procedure. Monopolar electrocautery is contraindicated but is still often
utilized; placing grounding pads as far away from the device can reduce the risk to device and patient.
Bipolar cautery is favored. Implanted cardiac devices can interfere with SCS, but risks can be minimized.
Neuraxial anesthesia can be attempted in a patient with implanted SCS, provided the device is not in
the expected path. MRI labeling differences present the biggest difference among SCS manufactures.
Medtronic’s SureScan SCS, Boston Scientific’s Precision system, St. Jude’s Proclaim, and Stimwave’s
Freedome SCS are full body MRI compatible under specific conditions, while other manufacturers have
labeling that restricts exams of the trunk and certain extremities.
Limitations: This review was intended to be a comprehensive, cumulative review of recommendations
for perioperative SCS management; however, the limitations of a review of this nature is the complete
reliance on previously published research and the availability of these studies using the methods outlined.
Conclusions: SCS is being used earlier in the treatment algorithm for patients with chronic pain. The
anesthesia care team needs working knowledge of where the device resides in the neuraxial space and
what risks different medical technologies pose to the patient and device. This understanding will lead to
appropriate perioperative management which can reduce risk and improve patient outcomes.
Key words: Spinal cord stimulation, perioperative management, MRI, anesthetic considerations,
CT scan, interventional pain management