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

Spinal Cord Series and Cases volume 9, Article number: 29 (2023) Cite this article

Subjects

Abstract

Study design

We retrospectively analyzed a database of implanted pulse generators (IPGs) for spinal cord stimulation (SCS) implanted by a single surgeon (NDT). We additionally report a series of five illustrative patient cases.

Objectives

The electronics of SCS IPGs are susceptible to damage when implanted patients undergo surgery. Some SCSs have a dedicated surgery mode, while others recommend turning the SCS off to protect it from damage. IPG inactivation may require resetting or replacement surgery. We aimed to explore the prevalence of this real-world problem which has not been studied.

Setting

Pittsburgh, Pennsylvania.

Methods

Using a single surgeon SCS database, we identified cases of IPG inactivation after a non-SCS surgery and analyzed the management. We then reviewed the charts of five illustrative cases.

Results

Among 490 SCS IPG implantations between 2016-2022, 15 (3%) of the 490 patients’ IPGs became inactivated after another non-SCS surgery. 12 (80%) required surgical IPG replacement, while 3 (20%) were able to have their IPG function restored non-operatively. In cases analyzed thus far, surgery mode was often not activated prior to surgery.

Conclusion

SCS IPG inactivation by surgery is not a rare problem and is presumably engendered by monopolar electrocautery. Premature IPG replacement surgery carries risks and reduces the cost-effectiveness of SCS. Awareness of this problem may prompt more preventative measures to be taken by surgeons, patients, and caretakers, and encourage technological advances to render IPGs less vulnerable to surgical tools. Further research is needed to determine what quality improvement measures could prevent electrical damage to IPGs.

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Data availability

Data are available from the corresponding author on reasonable request.

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Author information

Authors and Affiliations

  1. University of Toledo College of Medicine and Life Sciences, 3000 Arlington Ave, Toledo, OH, 43614, USA

    Jordan N. Norris

  2. Department of Neurosurgery, Allegheny Health Network, 320 East North Ave, Pittsburgh, PA, 15212, USA

    Nathan Esplin, Michael Patterson & Nestor D. Tomycz

  3. Lake Erie College of Osteopathic Medicine, 1858 W Grandview Blvd, Erie, PA, 16509, USA

    Rosh Bharthi

Authors
  1. Jordan N. Norris
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  2. Nathan Esplin
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  4. Michael Patterson
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  5. Nestor D. Tomycz
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Contributions

JNN acquired and analyzed the database findings and patients charts, prepared and formatted the manuscript. NE assisted with preparation and editing of the manuscript. RB assisted with preparation and editing of the manuscript. MP provided clinical insight and helped conceptualize the investigation. NDT is the senior author and helped conceptualize the investigation and contributed to manuscript editing and formatting.

Corresponding author

Correspondence to Jordan N. Norris.

Ethics declarations

Competing interests

NDT is on the surgeon advisory board at Boston Scientific and is a consultant for Abbot Neuromodulation.

Ethical approval

Conducted in accordance with the Allegheny Health Network Institutional Review Board, IRB #2022-250.

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Norris, J.N., Esplin, N., Bharthi, R. et al. Inactivation of spinal cord stimulator implanted pulse generators after elective surgery: an under-recognized problem. Spinal Cord Ser Cases 9, 29 (2023). https://doi.org/10.1038/s41394-023-00591-5

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  • DOI: https://doi.org/10.1038/s41394-023-00591-5

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