Peri‐procedural Management of Implanted Spinal Cord Stimulators in Patients Undergoing Radiofrequency Ablation: A Case Report and Manufacturer‐Specific Recommendations

Abstract

Introduction Radiofrequency ablation (RFA) and spinal cord stimulation (SCS) are 2 common modalities used in management of various pain conditions. RFA generates heat and an electromagnetic field that can theoretically interfere with the functionality and longevity of the SCS device. This is problematic for patients who need RFA and have previously undergone implantation of an SCS device. Case Description We present a case highlighting the safe use of bipolar RFA in a patient who had previously undergone implantation of a cervical SCS device. Discussion We also present device‐specific industry guidelines and recommendations for performing RFA in patients following SCS device implantation.

The American Society of Pain and Neuroscience (ASPN) Guidelines for Radiofrequency Ablative Procedures in Patients with Implanted Devices

“…Increased risk of damage or injury may occur if the RFA needle is near enough to the IPG, SCS lead, or any tissue near the leads. 17 In contrast, it has been reported that use of a bipolar RFA needle, which uses one active electrode and one ground electrode with a shorter inter-distance, has decreased risk since it provides the opportunity for precise and predictive ablation of the target. 19 …”

“…SCS devices are typically utilized in the setting of chronic axial or appendicular neuropathic pain, radicular pain, complex regional pain syndrome (CRPS), and failed back surgery syndrome, all of which are approved indications by the Food and Drug Administration (FDA). 17 Additional indications exist including chronic intractable angina, peripheral vascular disease, postherpetic neuralgia, central pain from multiple sclerosis (MS), visceral pain, and painful spasms of atypical stiff limb syndrome.…”

Perioperative and anesthetic considerations for the management of neuromodulation systems

“…However, the literature also includes two reported cases of RF-induced spinal cord stimulator malfunction and one case of DBS malfunction. Interestingly, both the case by Jeon et al in 2010 and the subsequent case by Abdullah et al in 2020 describe what appears to be spontaneous activation of a cervical spinal cord stimulator device during RF treatment of the cervical medial branches (despite both systems being turned off prior to RF), which resulted in painful upper extremity paresthesias 88 90. Fortunately, the painful paresthesia in both cases ceased after stopping the RF treatment, and there was no reported long-term harm to either patient or device in both instances.…”

“…RF procedures are often used as adjunctive pain treatments in patients with various implanted neuromodulation devices 88. The concomitant use of RF and implanted neuromodulation devices has been historically considered safe, especially when these devices are turned off prior to RF treatment.…”

“…Unfortunately, this patient subsequently suffered brain injury, with radiographical evidence of intracranial edema surrounding the electrodes, leading to a vegetative state. The authors speculate that RF fields may transmit synthesized electrothermal energy to adjacent implanted neuromodulation systems 88–91. Consequently, care must be taken in such circumstances, especially when target nerves are close in proximity to electrical components.…”