A Case of an Allergic Reaction to a Spinal Cord Stimulator: Identification of the Antigen With Epicutaneous Patch Testing, Allowing Successful Reimplantation

Allergy Considerations in Implanted Neuromodulation Devices

“…Maňoušek et al analyzed the polymer surface of unused electrodes from five manufacturers with XRF spectroscopy and found varying concentrations of aluminum, nickel, platinum, and tin present (32). In addition to these potential exposures, hypersensitivities to silicone, polyurethane, and titanium resulting in treatment failure have been reported (37)(38)(39).…”

“…Similarly, silicone composites may yield negative patch test results in spite of true allergenicity if the exact composite is not tested. Taverner reported negative patch test results after a silicone composite from a different model SCS was mistakenly sent from the manufacturer (38). In contrast, allergic reactions to other implantable devices, such as orthopedic or dental implants, are almost always against a metal, most commonly nickel, chromium, or cobalt in orthopedic implants and gold or mercury amalgam in dental implants (22).…”

“…In all cases, removal of the device resolved the local and systemic allergic response. Reimplantation with neuromodulation devices free of the offending allergen or coated with silicone were reported in two cases (38,72).…”

Spinal stimulator peri-electrode masses: case report

“…7,26,36 Manufacturers may provide samples for patch testing to aid in identifying the offending agent. A search of the literature relevant to spinal stimulators, deep brain stimulators, and pacemakers did not reveal any reports of allergic reactions manifesting as a peri-electrode mass.…”

“…2,29,35,38 Allergic reactions with cutaneous manifestations to the components of SCS systems have been reported. 3,7,26,36 Six cases are reported in the literature of a mass forming around paddle electrodes, causing spinal cord compression and myelopathy between 14 and 22 months after implantation (Table 1). 4,6,18,30,41 We review this literature and report a case of cervical cord compression with spastic quadriparesis secondary to a mass around percutaneous electrodes that occurred less than 1 year after implantation.…”