Inactivation of spinal cord stimulator implanted pulse generators after elective surgery: an under-recognized problem

Area of Science:

• Neurosurgery
• Biomedical Engineering
• Pain Management

Background:

• Spinal cord stimulation (SCS) implanted pulse generators (IPGs) are susceptible to damage during subsequent surgeries.
• Current protocols for protecting IPGs during surgery vary, with some recommending deactivation which may lead to complications.

Purpose of the Study:

• To investigate the real-world prevalence and management of SCS IPG inactivation following non-SCS surgeries.
• To identify factors contributing to IPG inactivation and inform preventative strategies.

Main Methods:

• Retrospective analysis of a single-surgeon database of 490 SCS IPG implantations (2016-2022).
• Identification and analysis of cases where IPGs were inactivated after non-SCS procedures.
• Review of five illustrative patient cases detailing management and outcomes.

Main Results:

• 15 out of 490 (3%) SCS IPGs were inactivated after non-SCS surgery.
• 80% (12 patients) required surgical IPG replacement; 20% (3 patients) had function restored non-operatively.
• Surgery mode was frequently not activated prior to the non-SCS procedure.

Conclusions:

• Surgical inactivation of SCS IPGs is a significant issue, likely caused by electrocautery.
• Premature IPG replacement increases risks and reduces the cost-effectiveness of SCS therapy.
• Increased awareness and preventative measures are crucial for surgeons, patients, and manufacturers to mitigate IPG damage.