The first step is a trial placement.
The trial is done by injecting local anesthetic into the back, inserting needles, usually two, and placing wires inside the spine, outside the dura.
Remember the description of epidural steroid injections.
The wires have a set of electrodes on them, and electric pulses are put through the wires.
The doctor will test the wires by electrically stimulating through them.
When you get a feeling of a buzz in the area of your pain, the wires are in the right places.
After the needles are removed (leaving the wires in place) the wires are secured in place with stitches in the skin.
Then they're hooked up to a trial stimulator and you take the whole thing home.
You get to play with the controls on the stimulator to see what gives you the best relief.
A few days later you show up again at the office and report the results.
If you say, "This was no stinking good! Get the wires out!" The doctor will cut the stitches and remove the wires.
Then you and the doctor will look for other diagnoses, or other ways to treat you.
If you say, "This is the best I've felt since I began to hurt!" he will still take the wires out.
Then you'll be set up for a permanent implant of the stimulator.
The Permanent Stimulator The permanent implant procedure starts the same as the trial, with local anesthetic, needles, and wire placement.
When the wires are properly placed they'll be connected to a small electronics package planted under the skin, usually in the upper outer buttock.
All the wires and electronics are secured inside the skin.
The surgery is done using a local anesthetic and some intravenous sedation.
The results from this are absolutely marvelous! Pain is well controlled and usually you don't need drugs for pain at all afterward.
You can quickly get back to normal activity.