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Sonication in Patients With Spinal Cord Stimulation: A New Approach for Infection Diagnostics
Adnan Kasapovic1, Gunnar Hischebeth2, Max Jaenisch1
1Department of Orthopedic and Trauma Surgery, University Hospital Bonn Venusberg Campus 1, Bonn, Germany.
Introduction:
Spinal cord stimulation (SCS) offers improvement in pain and function for several chronic pain conditions. There are concerns regarding bacterial colonization of the temporary lead extensions and subsequent infection risk in a two-session implantation procedure. Although there is no standardized evaluation of SCS lead contamination, this study evaluates the infection rate and microbial colonization of SCS lead extensions with sonication, a method that is established in implant-related infection diagnostics.
Materials And Methods:
This prospective observational study comprised 32 patients with a two-stage SCS implantation procedure. Microbial colonization of the lead extensions was assessed with sonication. The presence of organisms in the subcutaneous tissue was evaluated separately. Surgical-site infections were recorded. Patient demographics and risk factors including diabetes, tobacco use, obesity, trial length, and infection parameters in serum were recorded and analyzed.
Results:
The mean age of the patients was 55 years. On average, the trial length was 13 days. In seven cases (21.9%), a microbial lead colonization was found with sonication. In contrast, there was one positive culture (3.1%) from the subcutaneous tissue samples. The C-reactive protein and leukocyte count remained at the preoperative level. One early surgical-site infection (3.1%) occurred. No other late infections occurred six months after surgery.
Conclusions:
There is a discrepancy between the presence of microbial colonization and the occurrence of clinically relevant infections. Although the rate of microbial colonization of the lead extensions is high (21.9%), the surgical-site infection rate remained low (3.1%). Therefore, we can conclude that the two-session procedure is a safe approach that is not associated with a higher incidence of infection. Although the sonication method cannot be used as the sole tool for detecting infections in patients with SCS, it can provide additional value in microbial diagnostics in combination with clinical and laboratory parameters and conventional microbiological methods.
Insights
This study found that while microbial colonization of spinal cord stimulation (SCS) lead extensions is common in two-stage procedures, the actual infection rate remains low, indicating the procedure
Area of Science:
- Neurosurgery
- Infectious Disease
- Medical Device Technology
Background:
- Spinal cord stimulation (SCS) is effective for chronic pain but raises infection concerns with two-stage implantation.
- Bacterial colonization of temporary lead extensions is a potential risk factor for SCS infections.
- Standardized methods for evaluating SCS lead contamination are lacking.
Purpose of the Study:
- To evaluate the infection rate and microbial colonization of SCS lead extensions using sonication.
- To assess the safety and infection risk associated with a two-session SCS implantation procedure.
Main Methods:
- Prospective observational study of 32 patients undergoing two-stage SCS implantation.
- Microbial colonization of lead extensions assessed via sonication.
- Surgical-site infections and relevant patient risk factors were recorded and analyzed.
Main Results:
- Microbial colonization of lead extensions was detected in 21.9% of cases via sonication.
- Subcutaneous tissue cultures yielded positive results in only 3.1% of cases.
- A low surgical-site infection rate of 3.1% was observed, with no late infections.
Conclusions:
- A high rate of microbial colonization does not necessarily translate to clinical infection in SCS procedures.
- The two-session SCS implantation approach is a safe method with a low incidence of infection.
- Sonication can supplement, but not replace, conventional methods for microbial diagnostics in SCS.
