Spinal Cord Stimulation Q&A with Dr. Joseph Christiano

September 28, 2018

Procedural Questions

Q: How Long Is the Hospital Stay?
A: Both the trial and permanent placement procedures are often performed on an outpatient basis. At times, patients will spend one night in the hospital after the permanent implantation procedure.

Q: I Feel New Pain After Surgery. Has the Procedure Failed?
A: It is not uncommon to feel some pain or discomfort from the surgical procedure itself for up to a week after the procedure. If you are concerned about the pain or if the pain intensifies, please contact our office and we will be more than happy to answer your questions.

Q: When Can I Return to Normal Activity?
For the first two weeks after surgery, you will be encouraged to walk and perform non-strenuous exercises within your physical limits. These exercises should not stretch or twist the spine or back. During this time, we will want you to minimize time spent sitting. You will not be able to drive. Strenuous activity should be avoided for at least 4-6 weeks or until cleared by our office.

Q: Is There Anything I Cannot Do After the Recovery Period?
A: Patients will be able to return to most of their normal activities after the 4-6 week recovery period. Chiropractic manipulation should be avoided or should be discussed with your surgeon. Extremely strenuous activities involving back muscles and torsion can cause complications as well.

Q: Will I Feel or See the Implant?
A: Implants are getting smaller with a lower profile. However, since the pulse generator is implanted directly under the skin you will be able to feel it when pressing on the area. Others will most likely not see the implant when looking casually. Patients will get used to the implant’s presence very soon after the procedure.

Stimulator Features and Use

Q: Do I have Control Over the Stimulation Settings?
A: Yes. Your pain will vary throughout the day due to natural cycles, activity and other considerations. You will be able to modify certain stimulation settings to address your pain levels at any given time. The stimulator may also be adjusted more precisely by a technician at our office.

Q: How Many Hours Per Day Should the Stimulator Be Used?
The stimulator has been tested and approved for all day use. As such, you can decide to use the it 24 hours a day or on an as needed basis. It largely depends on your comfort level at any given time. Many patients sleep with their stimulator on a low setting or turned off. Others keep a consistent setting day and night.

Q: Will I Feel Sensations?
A: Some patient report feeling mild sensations, while others feel nothing. Almost all quickly become accustomed to any sensation they may have from the SCS. You should not feel significant discomfort or new or worsened pain when you turn on your stimulator.

Q: Will I Set Off Alarms at Airports?
A: You may or may not set off a metal detector, depending on its sensitivity. You will be given an implant card to let authorities know that you have the device.

Q: What About Diagnostic Imaging?
A: Most standard diagnostic imaging is compatible with your implant; however you should always let your doctor and the imaging center know that you have an implanted SCS.

Q: How Do I Charge the Battery?
A: Charging the battery is a straightforward process. The charger is portable and wireless and simply needs to be placed over the pulse generator. Our technicians will give you specific instructions based on the model of SCS you have.

Results & Effectiveness

Q: Will I be Pain Free After My SCS?
A: SCS is not meant to eliminate all pain, however we expect that pain will be reduced significantly enough to resume activities that the pain may have once precluded. Your trial period will give you a good idea of how much pain to expect after the permanent implant.

Q: Do I Need to Continue on Pain Medication?
A: Depending on how much relief you receive from SCS, you may or may not need to continue your pain medications. Some patients may be able to transition from narcotic to non-narcotic pain medications. Your post-operative visits and pain level history will help us determine the best course of action for your particular circumstance.

Complications and Considerations

Q: Are There Any Risks to SCS?
A: Yes, as with any procedure involving surgery, especially in and around the spine, there are risks. In the hands of an experienced neurosurgeon and by following proper aftercare protocols, these risks can be mitigated. We will discuss your specific risks fully at consultation and you will receive a post-operative packet with instructions on how to minimize common risks associated with SCS implantation.

Q: Can the SCS be Removed?
A: While SCS is meant to be a permanent implant, there are cases where the device can be removed. This is very rarely needed but is a simple outpatient procedure.

Q: Does the Battery Ever Wear Out?
A: Depending on the manufacturer the SCS comes with a long-term warranty against defects and early expiration. If it should fail during or after this period, the replacement of the pulse generator is a relatively straightforward and quick procedure that does not require the repositioning of the leads. As such recovery time is short and discomfort is minimized.

Final Thoughts

Spinal Cord Stimulation procedures have been successfully performed on hundreds of thousands of patients and can truly give you your life back. For most patients, SCS represents a viable, effective option when narcotic medications and complex surgeries are not acceptable options.



Dr. Joseph Christiano, Jr. is a Board-Certified Neurosurgeon with specialty training in Surgical Pain Management and Movement Disorder surgery.

Dr. Christiano has additional expertise in Spinal Cord Stimulation, Surgical Pain Management and Deep Brain Stimulation for Parkinson’s Disease and Tremor.

Stroke Question and Answer

March 17, 2018

What Is a Stroke?

A stroke occurs when the flow of oxygenated blood to the brain is obstructed. During a stroke, affected brain tissues receive less oxygen, leading to cell damage and possibly death.There are two types of stroke:

  1. Ischemic stroke occurs when blockage prevents blood-flow within a vessel. Blockage is often the result of a blood clot or similar structure. Atherosclerosis, hypertension, high cholesterol, diabetes and smoking are all risk factors that may increase the likelihood of Ischemic Stroke.
  2. Hemorrhagic Stroke occurs when a blood vessel breaks, or is ruptured. Ruptures disrupt circulation and increase intracranial pressure, leading to cell death. Hypertension and aneurysm are risk factors that may increase the likelihood of Hemorrhagic Stroke.

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What You Need to Know About TIA & Stroke

February 4, 2018

Why Does the Brain Need Oxygen?

The brain uses energy to relay chemical signals and commands to other organ systems throughout the body. Of all the organ systems, the brain and nervous system require the most energy. The brain receives nutrients and oxygen from the circulatory system. Red blood cells use proteins like hemoglobin to transport oxygen, carbohydrates, amino acids, hormones, fats and vitamins to neural cells.

What Happens When the Brain Does Not Receive Oxygen?

When circulatory pathways are blocked or ruptured, cells do not receive oxygen and begin to die. The death of neural tissue can lead to permanent damage, and in some cases, death. The American Heart Association (AHA) identifies stroke as being the fifth-leading cause of death amongst Americans. Roughly one in twenty deaths is the result of a stroke.

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Alzheimer’s Q&A with Western Neuro

August 12, 2017

This month’s Q&A is about Alzheimer’s Disease or AD, the most common form of dementia. This disease affects millions of Americans and its causes remain largely unknown. A diagnosis can be scary both for the patient and their family. In today’s Q&A we discuss common questions.

Q: Some people use the tongue-in-cheek moniker “Old Timer’s Disease” to describe Alzheimer’s Disease. Is AD an inevitable part of aging? 

A: While the primary risk factor for Alzheimer’s Disease is age, AD is not a normal part of aging. We all become more forgetful as we age, but the symptoms of AD are more pronounced and debilitating. While there is no definitive diagnosis for AD, we can usually identify a case of Alzheimer’s with a high degree of certainty.

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Alzheimer’s Disease Linked to Microbial Infections, New Research Suggests

July 31, 2017


Alzheimer’s Disease (AD) is a neurodegenerative disease that induces cell death and subsequent declines in processing and cognitive function. Alzheimer’s, a form of dementia, is widespread amongst aging populations. Nearly one out of every three elderly deaths are the result of Alzheimer’s Disease, making AD the 6th leading cause of death in the United States. Figures estimate that over 5 million Americans currently live with Alzheimer’s Disease, with this number projected to increase. Though the effects of Alzheimer’s are well documented, the exact cause of the disease is unknown. Recent findings, however, suggest that Alzheimer’s may be the result of microbial infections in the brain.

How is Alzheimer’s Formed?

Brain cells, known as neurons, relay information through specialized sites known as synapses. Synapses allow chemical structures, called neurotransmitters, to diffuse across neurons and relay communicative signals.

Traditional theories suggest that Alzheimer’s disease may be the result of blockage across chemical synapses. As individuals age, fragments of beta-amyloid proteins begin to clump together. These clumps combine to form chemically “sticky” plaques in the synapses between neurons. These plaques inhibit transmission and communication amongst neurons, leading to cognitive decline and cell death.

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Prevention of Sports Related Head Injuries

December 12, 2016

It has been said that we have a silent epidemic among our young athletes – Brain Injuries due to Concussion. Athletes age 14 and under account for 1/3 of Emergency Room evaluations for sports’ related head injuries. 60% of these Brain Injuries occurred in football & basketball. In the last 10 years, emergency room visits by children and adolescents with sports related concussions nearly doubled in organized team sports in the 8-13 age group and nearly tripled in the age 14-19 group. Symptoms such as confusion, dizziness, headache, slowed reaction times and memory problems are just some of the most common symptoms of a concussion. 90% of concussions occur without loss of consciousness. A player who has sustained one concussion is 3 to 6 times more likely to sustain a second concussion and studies have indicated that 14.7% of high school and college players suffer more than one concussion during the season.

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