Biologic Complications Associated with Cylindrical Lead Spinal Cord Stimulator Implants: A Narrative Review

Orthopedic Reviews, 2024 · DOI: 10.52965/001c.123443 · Published: January 1, 2024

Simple Explanation

Spinal cord stimulation (SCS) is a treatment for severe nerve pain, but it can lead to complications. This review focuses on biologic complications, which are less common than device-related issues but can be more serious. Biologic complications include infections, seromas, hematomas, dural puncture, nerve/spinal cord injury, and therapy habituation. The review discusses the causes, symptoms, diagnosis, and treatment options for these biologic complications associated with cylindrical SCS implantation.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Level 5, Narrative Review

Key Findings

1
Infections are a potential complication, often caused by bacteria like streptococcus and staphylococcus, and may require device removal.
2
Hematomas can occur, with epidural hematomas potentially causing neurological deficits and requiring urgent surgical intervention.
3
Dural punctures can lead to post-dural puncture headaches (PDPH), which are usually treated with conservative measures or epidural blood patches.

Research Summary

This review consolidates recent research on biologic complications associated with spinal cord stimulation (SCS), emphasizing the importance of understanding these risks for patient safety and optimal outcomes. The biologic complications discussed include infections, seromas, hematomas, dural puncture, nerve/spinal cord injury, and therapy habituation, with detailed information on their management. The conclusion stresses the need for clinicians to carefully consider potential complications before SCS trials and implantation, highlighting the importance of familiarity with biologic complications.

Practical Implications

Infection Prevention

Strict adherence to sterile techniques and postoperative monitoring can reduce infection rates.

Hematoma Management

Careful patient selection and monitoring for bleeding disorders can minimize hematoma risk; prompt diagnosis and intervention are critical for epidural hematomas.

PDPH Treatment Protocols

Implementing standardized protocols for managing post-dural puncture headaches, including conservative measures and timely epidural blood patches, can improve patient comfort and outcomes.

Study Limitations

1
Limited data regarding re-infection rates due to high variability in implant location change, timing of surgery, and preoperative preparation practices
2
Loss of SCS efficacy over time
3
Small sample size

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