Safety considerations for spinal surgery in patients with deep brain stimulation devices

Deep brain stimulation (DBS) has been performed for various brain disorders. However, spinal surgery in patients with DBS was been approached with cautious trepidation due to risk of thermal brain injury and device damage from coagulation devices during surgery. This study presents the cases of successful spinal surgery performed after DBS implantation.

We retrospectively reviewed the patients who received spinal surgery after DBS implantation between April 2001 and November 2022. We reviewed their demographic data, preoperative evaluations, and surgical strategies employed.

Among 348 patients who underwent DBS implantation, eight patients received spinal surgery. The methods used for diagnosing their spinal conditions varied: two cases of computed tomography (CT) myelogram, one case of CT scan with pre-DBS magnetic resonance imaging (MRI), one case of CT scan only, and four cases of post-DBS MRI. The location of the spinal surgery were one case of cervical spinal surgery, three cases of thoracolumbar spinal surgery, and four cases of lumbar spinal surgery. We followed diagnostic study guidelines and safety considerations tailored to each surgical step. Monopolar and bipolar coagulation devices were used when necessary. There were no cases of complications caused by spine surgery regarding DBS function or DBS implanted site.

Careful execution of surgical procedures, adherence to safety guidelines, and the use of MRI for diagnosis can ensure safe and successful spinal surgery in patients with DBS implants, minimizing the risk of damage to the DBS system and the brain.