Allergic Reaction to Spinal Cord Stimulator

Ochani, Teekam D.; Almirante, James; Siddiqui, Afzaal; Kaplan, Ronald

doi:10.1097/00002508-200006000-00012

Cited by 24 publications

(16 citation statements)

References 16 publications

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“…has started implanting the generator in a more rostral position (flank between iliac crest and ribs) when patient habitus permits. One patient had itchiness at the IPG and lead sites, indicating a result consistent with previously mentioned allergic reactions to SCS . The wound infection rate was 8.5%, which is consistent with previously cited values .…”

Section: Discussionsupporting

confidence: 90%

“…Surgical paddle lead placement has been associated with slightly higher initial postoperative complication rates when compared to percutaneous lead placement, but long‐term costs and reoperation rates have been shown to be lower in surgical paddle lead placement cohorts . Previously described reasons for removal include infection (2% to 13%), erosion of implanted pulse generator (IPG), new thoracic radiculopathy, inadequate pain coverage (IPC), allergic inflammatory reactions, and patient dissatisfaction . There are ongoing technological and engineering advances aimed at addressing some of the most common reasons for SCS failure and subsequent explantation .…”

Section: Introductionmentioning

confidence: 99%

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Spinal Cord Stimulator Explantation: Motives for Removal of Surgically Placed Paddle Systems

et al. 2017

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Inadequate pain control is the most common reason for SCSES. Advances in technology are needed to improve the quality and duration of pain control, as well as to design improvements to make the hardware more comfortable. A significant number of implants are removed due to need for MRI, a fact obviating the need for MRI-compatible systems. Patients considering SCS paddle lead placement should be counseled on the most common reasons for later explantation.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Spinal Cord Stimulator Explantation: Motives for Removal of Surgically Placed Paddle Systems

et al. 2017

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“…However, the true incidence may be underestimated because clinicians may fail to include it in the differential diagnosis, attributing an inflammatory reaction of the soft tissue surrounding SCS components to infection. In addition, only two articles detail the cutaneous reaction to the components of SCS systems 6,7. The purpose of this paper is to detail the presentation, clinical course, and histologic findings in three patients with cutaneous reactions to spinal cord stimulator equipment components.…”

Section: Introductionmentioning

confidence: 99%

Detailed analysis of allergic cutaneous reactions to spinal cord stimulator devices

Chaudhry¹,

Najib²,

Bajwa³

et al. 2013

JPR

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The use of spinal cord stimulation (SCS) devices to treat chronic, refractory neuropathic pain continues to expand in application. While device-related complications have been well described, inflammatory reactions to the components of these devices remain underreported. In contrast, hypersensitivity reactions associated with other implanted therapies, such as endovascular and cardiac rhythm devices, have been detailed. The purpose of this case series is to describe the clinical presentation and course of inflammatory reactions as well as the histology of these reactions. All patients required removal of the entire device after developing inflammatory reactions over a time course of 1–3 months. Two patients developed a foreign body reaction in the lead insertion wound as well as at the implantable pulse generator site, with histology positive for giant cells. One patient developed an inflammatory dermatitis on the flank and abdomen that resolved with topical hydrocortisone. “In vivo” testing with a lead extension fragment placed in the buttock resulted in a negative reaction followed by successful reimplantation of an SCS device. Inflammatory reactions to SCS devices can manifest as contact dermatitis, granuloma formation, or foreign body reactions with giant cell formation. Tissue diagnosis is essential, and is helpful to differentiate an inflammatory reaction from infection. The role of skin patch testing for 96 hours may not be suited to detect inflammatory giant cell reactions that manifest several weeks post implantation.

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

Spinal stimulator peri-electrode masses: case report

Scranton

Skaribas²,

Simpson

2015

SPI

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The authors describe a case of delayed spastic quadriparesis caused by a peri-electrode mass following the implantation of a minimally invasive percutaneous spinal cord stimulator (SCS). Prior reports with paddle-type electrodes are reviewed, and a detailed histological and pathophysiological comparison with the present case is made. The patient developed tolerance to a cervical percutaneous SCS 4 months after implantation, followed by the onset of spastic quadriparesis 9 months after implantation. The stimulator was removed, and contrast-enhanced MRI revealed an enhancing epidural mass where the system had been placed, with severe spinal cord compression. Decompression was carried out, and the patient experienced neurological improvement. Pathological examination revealed fibrotic tissue with granulomatous and multinucleated giant cell reactions. No evidence of infection or hemorrhage was found. Professionals treating patients with SCSs or contemplating their insertion should be aware of this delayed complication and associated risk factors.

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Allergic Reaction to Spinal Cord Stimulator

Cited by 24 publications

References 16 publications

Spinal Cord Stimulator Explantation: Motives for Removal of Surgically Placed Paddle Systems

Spinal Cord Stimulator Explantation: Motives for Removal of Surgically Placed Paddle Systems

Detailed analysis of allergic cutaneous reactions to spinal cord stimulator devices

Spinal stimulator peri-electrode masses: case report

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