![]() Coexisting diseases and conditions should receive the focus of the clinician. Expectations should be discussed and the risk of complications should be outlined. Prior to surgery, the patient should be interviewed regarding preexisting deficits and complaints, which should be documented. Revision of connectors, generator, or leads Reprogramming of device, revision of leads Pressure and aspiration, surgical revisionĪntibiotics, incision and drainage, removal Positional headache, blurred vision, nauseaĪspiration, if no response surgical drainage Surgical evacuation, IV antibiotics, ID consult Physical exam, CT or MRI, CBC, blood work Steroid protocol, anticonvulsants, neurosurgery consult The severity of complications varies from minor problems such as simple skin irritations or the need for computer programming to more dangerous complications such as epidural bleeding and paraplegia. In another analysis, Kumar found lead complication rates to be 5.3%, a low infection rate of 2.7%, and an epidural fibrosis rate of 19%. In some instances, the investigator may be more experienced than the typical implanter resulting in better overall outcomes, or the outcomes may be significantly worse because of the severity of the patient disease states and the demands of a teaching environment. The accuracy of these stated rates are difficult to interpret because of the variability of the populations involved in the different studies. Turner analyzed the available evidence-based studies over the past decade and found an overall complication rate of 34%, a complication rate leading to surgical revision in 23%, and a serious complication rate at less than 1%. ![]() Complicationsĭue to the inherent difficulty of identifying complications by peer review and closed claim analysis, the incidence of complications with SCS is unknown.Īn overview of complications is provided in Table 1 based on information published by Turner and Cameron (see Table 1). They also must be psychologically stable, and if they suffer from comorbid depression, anxiety disorder, drug addiction, systemic infections, or bleeding disorders, these conditions must be successfully managed before proceeding. Prior to moving forward with a permanent implant, the patient should have a trial that provides significant relief. The most common disease states that are treated with SCS include failed back surgery syndrome, lumbar or cervical radiculitis, peripheral neuropathy, complex regional pain syndrome, post-herpetic neuralgia, spinal stenosis, pelvic pain, angina, ischemic pain, peripheral nerve injuries, and nerve plexus injuries. This technique is indicated in patients with moderate to severe pain of the limbs or trunk that has failed more conservative approaches. Once the lead is in proper position, as determined by patient response or X-ray confirmation, a subcutaneous pocket is made and tunneling tool is used to place wires from the leads to a generator. The technique involved with the placement of these implants requires the placement of a programmable lead into the epidural space by either a percutaneous needle approach or an open surgical approach. Since the initial use of SCS by Shealy, the devices have changed from bipolar leads with an external power source to multi-contact leads with rechargeable generators. Much like the history of electrical therapies for the treatment of disease, spinal cord stimulation (SCS) has seen a major evolution since it was first reported in the literature four decades ago. It is the goal of this paper to expand on Franklin's previous report and give a comprehensive look at current complications of spinal cord stimulation. He reported that in his experience, the relief provided was often overridden by complications including skin burns and pain with increasing current and voltage. The first recorded skeptic of these therapies was the American statesman, Benjamin Franklin. In regard to pain relief and neurological diseases, early reports were optimistic for the use of this treatment for headaches, joint pain, hysteria, and depression. Further work revealed that electricity is involved in muscle movement, neurological function, and pain perception. During that time period, energy was harnessed in crude capacitors called Leyden jars. In the 1700s, several great minds worked on the concept of capturing electricity to be used to help the suffering. The evolution of these therapies can be traced from Ancient Greeks using torpedo fish to treat arthritis and other disease states. Spinal Cord Stimulation, Complications, Prevention, Risks IntroductionĮlectrical current has been used to treat disease for thousands of years.
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