Dr. Amir Hussein Faraji, FCNS, MD, PhD

DBS surgery may be completed in one operating session, but it is more commonly performed in two parts. In the first stage of the procedure, the surgeon will map targets in the brain using CT or MRI imaging to determine where to place the electrodes. Then, by drilling holes into the skull, the surgeon will place the electrodes into specific areas in the brain. The holes will be closed, and patients will require 1-2 days to recover in the hospital. After about two weeks, patients will undergo another surgery to have the deep brain stimulator implanted. The stimulator is usually placed under the skin around the collarbone, chest, or abdomen, and it will be connected to the DBS electrodes through a subcutaneous wire. No component of the DBS system will be visible from outside. Following stimulator implantation, patients may need to recover in the hospital for 1-2 days.

Within 2-4 weeks of the operation, doctors will program the stimulator using a wireless device. Patients will work with their doctor to determine the most effective settings for the stimulator during follow-up visits. Patients will be given a handheld device so that they can turn the stimulator on or off and adjust its settings themselves. The stimulator may have a rechargeable battery, in which case patients will be given a charging unit. Stimulator batteries generally need to be replaced in 3-5 years.

To determine if spinal cord stimulation may benefit someone, they will first undergo a trial period. During this period, a temporary electrode lead is placed subcutaneously above the spinal cord, and it is connected to an external stimulator that they will carry with them. The procedure is typically completed within an hour, and patients may return home the same day. After a few days or weeks, the trial stimulator will be assessed for effectiveness. If the trial is unsuccessful, patients may undergo a second trial period, or the leads will be removed, and other treatment options will be considered. If, instead, a patient's pain is relieved during the trial, they will undergo surgery for implantation of a permanent stimulator and leads.

The components of a spinal cord stimulation system include the stimulator, the leads, and the wire that connects the two. Implantation of permanent leads may be percutaneous (through the skin) or involve a surgical incision. The spinal cord stimulator is implanted subcutaneously in the abdomen or buttock. The stimulator is battery-powered and may be rechargeable. If the battery is not rechargeable, it will last around 2-5 years, and a patient will need surgery to replace it.Their doctor will program the neurostimulator following the procedure.

After spinal cord stimulator surgery, patients may be released from the hospital the same day or the next one. In the weeks following the operation, patients will need to work with their doctors to find the optimal settings for their neurostimulator. Activities such as driving, twisting, bending, raising one's arms, sleeping on one's stomach, or lifting heavy objects should be limited.