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Spinal Cord Stimulator Related Infections: Findings From a Multicenter Retrospective Analysis of 2737 Implants
Markus A Bendel1, Travis O'Brien1, Bryan C Hoelzer1
1Mayo Clinic, Rochester, MN, USA.
Introduction:
Surgical site infection is a potential complication of spinal cord stimulator (SCS) implantation. Current understanding of the epidemiology, diagnosis, and treatment of these infections is based largely on small clinical studies, many of which are outdated. Evidence-based guidelines for management of SCS-related infections thus rely instead on expert opinion, case reports, and case series. In this study, we aim to provide a large scale retrospective study of infection management techniques specifically for SCS implantation.
Methods:
A multicenter retrospective study of SCS implants performed over a seven-year period at 11 unique academic and non-academic institutions in the United States. All infections and related complications in this cohort were analyzed.
Results:
Within our study of 2737 SCS implant procedures, we identified all procedures complicated by infection (2.45%). Localized incisional pain and wound erythema were the most common presenting signs. Laboratory studies were performed in the majority of patients, but an imaging study was performed in less than half of these patients. The most common causative organism was Staphylococcus aureus and the IPG pocket was the most common site of an SCS-related infection. Explantation was ultimately performed in 52 of the 67 patients (77.6%). Non-explantation salvage therapy was attempted in 24 patients and was successful in resolving the infection in 15 patients without removal of SCS hardware components.
Discussion:
This study provides current data regarding SCS related infections, including incidence, diagnosis, and treatment.
Insights
Surgical site infections (SSIs) complicate spinal cord stimulator (SCS) implants. This study analyzed 2737 SCS procedures, finding a 2.45% infection rate, with Staphylococcus aureus being common. Management strategies varied, with explantation in 77.6% of cases.
Area of Science:
- Neurosurgery
- Infectious Disease
- Medical Device Technology
Background:
- Surgical site infection (SSI) is a known complication of spinal cord stimulator (SCS) implantation.
- Current management guidelines for SCS-related infections are based on limited, often outdated, clinical studies.
- There is a need for large-scale, contemporary data on SCS infection epidemiology, diagnosis, and treatment.
Purpose of the Study:
- To conduct a large-scale retrospective analysis of spinal cord stimulator (SCS) implantation procedures.
- To investigate the incidence, causative organisms, and management strategies for SCS-related infections.
- To provide updated insights into the diagnosis and treatment of SCS infections.
Main Methods:
- A multicenter retrospective study involving 2737 SCS implant procedures across 11 institutions in the United States.
- Analysis of all identified infections and associated complications over a seven-year period.
- Review of diagnostic methods, causative pathogens, infection sites, and treatment outcomes, including explantation and salvage therapies.
Main Results:
- An overall infection rate of 2.45% was observed among the 2737 SCS implant procedures.
- The most frequent presenting signs were localized incisional pain and wound erythema.
- Staphylococcus aureus was the most common pathogen, and the implantable pulse generator (IPG) pocket was the most frequent infection site. Explantation was performed in 77.6% of infected cases.
Conclusions:
- This study offers current epidemiological data on spinal cord stimulator (SCS) related infections.
- Findings highlight common clinical presentations, pathogens, and infection locations.
- The results provide valuable insights into current diagnostic and treatment approaches for SCS infections, including the success of salvage therapies.
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