![]() The most current guidelines about recommended practices to reduce surgical site infections-released in 2016 at the Neurostimulation Appropriateness Consensus Committee (NACC)-coincide with the CDC guidelines for prevention of surgical site infections. , However, the SCS literature has no consensus to recommend routine use of those methods. Clinicians have started placing vancomycin powder or multidrug eluding envelopes at the pocket site to help reduce the infection rate based on evidence from the neurosurgical and cardiac literature. Interest is increasing in developing methods to reduce infection at the pocket site. However, Hoelzer et al found that those comorbidities did not increase the risk of SCS-specific surgical site infections instead, the review demonstrated a significant decrease in infection rates with the use of postoperative occlusive dressings and postoperative antibiotics. In the surgical literature, diabetes, tobacco abuse, and obesity have been identified as the most common risk factors for surgical site infections. However, in a recent multicenter, retrospective review, Hoelzer et al looked at 2,737 SCS implants and found an overall infection rate of 2.45%. Infection rates range from 2%–10% based on multiple retrospective and randomized controlled studies. Infections can develop in the superficial, deep, and epidural levels but most commonly in the pocket site created for the implanted generator. The most significant biologic complication results from implanting the SCS device. Biologic complications include infection following SCS implantation, neurologic injury, epidural hematoma, skin erosion, epidural fibrosis, dural puncture, pain, and allergic reaction to the device. However, they occur at a lower frequency than device-related complications. Biologic Complicationsīiologic complications present a larger concern for practitioners. The best way to assess for battery failure is to have the manufacturer representative evaluate the device. Cameron’s review showed a 1.7% battery failure rate, but nearly 69% of those occurred after three years, which may be indicative of battery life versus true failure rate. The major issue with lead migration is impairment of SCS function, leading to revision, replacement, or explant of the device, thus increasing the risk of further complications.īattery failures are less common than lead failures, although much less information is available in the literature, especially for newer, rechargeable systems. Other studies have shown comparable lead migration rates between paddle and percutaneous leads. , Paddle electrodes may have a decreased risk of lead migration but an increased rate of immediate postoperative complications, such as neurologic injury and epidural hematoma. More recent literature reviews reported higher rates, ranging from 20%–22.6%. In 2004, Cameron conducted a 20-year literature review demonstrating a lead migration rate of 13.2%. Lead migration is the most common complication of SCS. Lead fracture or disconnect occurs in 5.9%–9.1% of devices and is diagnosed through imaging of the lead or checking lead impedances. Hardware failure is primarily associated with the lead and often described by patients reporting a change in device stimulation. In 2014, Deer et al further separated device-related complications into two categories: hardware failure and battery failure. Biologic complications include infection, epidural hemorrhage, seroma, paralysis, cerebrospinal fluid (CSF) leakage, pain over implant site, allergic reaction, and skin breakdown. Device-related complications consist of lead migration, lead breakage, over or under stimulation, intermittent stimulation, hardware malfunction, loose connections, battery failure, and failure to communicate with the generator. Complications, however, are estimated to range from 30%–40%, and can be divided into two categories: device-related failure or biologic factors. SCS is thought to be a safe, minimally invasive procedure for management of a variety of painful conditions. However, as with any treatment modality, associated risks accompany the benefits of SCS.Ĭomplications, however, are estimated to range from 30%–40% and can be divided into two categories: device-related failure or biologic factors. Neuromodulation, specifically spinal cord stimulation (SCS), presents a viable option for nonpharmacologic management of a subset of patients suffering from chronic pain. Current Centers for Disease Control and Prevention (CDC) guidelines for pain management recommend nonpharmacologic and non-opiate pharmacologic management of chronic pain symptoms. Recent years have seen a trend toward nonpharmacologic treatment of pain, which has occurred secondary to the increasing evidence of the lack of efficacy of opiates and other pain medications. Pain is an important factor in determining a patient’s quality of life.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |