Complications of Spinal Cord Stimulation: Identification, Treatment, and Prevention

Abstract

A B S T R A C TSpinal cord stimulation is a therapy used for the relief of neuropathic pain of the trunk and limbs. The therapy was first reported four decades ago, and has improved in many areas including technical equipment, patient selection, and physician training. Despite these advances, complications are still seen with both the implantation and long-term use of these devices. This article gives an overview of the identification, treatment, and follow-up care of patients suffering complications. A close analysis is also made of clinical assessment and actions that are important in reducing or preventing these sometimes devastating events.

The Neurostimulation Appropriateness Consensus Committee (NACC) Safety Guidelines for the Reduction of Severe Neurological Injury

“…The working group then developed weighted recommendations based on the evidence ranking, and identified need for consensus when evidence DEER ET AL. www.neuromodulationjournal.com V C 2017 International Neuromodulation Society Neuromodulation 2017; 20: [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] was poor. The working group, via in-person meetings, teleconference, or electronic communications, created the consensus, with a quorum defined as 80% of the contributing authors.…”

“…Surgical site infections (SSIs) associated with SCS implantation can lead to serious neurological complications (5,18,(35)(36)(37)(38)(39). Both epidural abscess and meningitis have been reported in the setting of SCS-related SSIs (5,18,22,35,(38)(39)(40)(41)(42). If not diagnosed and treated promptly, SSIs can lead to sequelae including paralysis and death.…”

Polyanalgesic Consensus Conference—2012: Recommendations to Reduce Morbidity and Mortality in Intrathecal Drug Delivery in the Treatment of Chronic Pain

“…The choice of preoperative antibiotic administration should be based on local pathogens and sensitivity. The use of postoperative antibiotics is lacking in the literature, but the majority of the PACC do use postoperative antibiotics (26).…”

The Incidence and Management of Postdural Puncture Headache in Patients Undergoing Percutaneous Lead Placement for Spinal Cord Stimulation

“…SCS therapy is however not free from complications. The frequency of minor complications is upwards of 30% and this has been well documented in the literature . These complications are commonly divided into mechanical (hardware) and biological .…”