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.
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.
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.
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.
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.
This is a preview of subscription content, access via your institution
Subscribe to this journal
Receive 1 print issues and online access
We are sorry, but there is no personal subscription option available for your country.
Rent or buy this article
Prices vary by article type
Prices may be subject to local taxes which are calculated during checkout
Data are available from the corresponding author on reasonable request.
Amirdelfan K, Yu C, Doust MW, Gliner BE, Morgan DM, Kapural L, et al. Long-term quality of life improvement for chronic intractable back and leg pain patients using spinal cord stimulation: 12-month results from the SENZA-RCT. Qual Life Res. 2018;27:2035–44.
Kemler MA, Barendse GA, van Kleef M, de Vet HC, Rijks CP, Furnée CA, et al. Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. N Engl J Med. 2000;343:618–24.
North RB, Kidd DH, Farrokhi F, Piantadosi SA. Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial. Neurosurgery. 2005;56:98–106.
de Vos CC, Meier K, Zaalberg PB, Nijhuis HJ, Duyvendak W, Vesper J, et al. Spinal cord stimulation in patients with painful diabetic neuropathy: a multicentre randomized clinical trial. Pain. 2014;155:2426–31.
Zipes DP, Svorkdal N, Berman D, Boortz-Marx R, Henry T, Lerman A, et al. Spinal cord stimulation therapy for patients with refractory angina who are not candidates for revascularization. Neuromodulation. 2012;15:550–8.
Kumar K, Hunter G, Demeria D. Spinal cord stimulation in treatment of chronic benign pain: challenges in treatment planning and present status, a 22-year experience. Neurosurgery. 2006;58:481–96.
Mekhail NA, Mathews M, Nageeb F, Guirguis M, Mekhail MN, Cheng J. Retrospective review of 707 cases of spinal cord stimulation: indications and complications. Pain Pr. 2011;11:148–53.
Gazelka HM, Freeman ED, Hooten WM, Eldrige JS, Hoelzer BC, Mauck WD, et al. Incidence of clinically significant percutaneous spinal cord stimulator lead migration. Neuromodulation. 2015;18:123–5.
Harned ME, Gish B, Zuelzer A, Grider JS. Anesthetic considerations and perioperative management of spinal cord stimulators: literature review and initial recommendations. Pain Physician. 2017;20:319–29.
von Olshausen G, Rondak IC, Lennerz C, Semmler V, Grebmer C, Reents T, et al. Electromagnetic interference in implantable cardioverter defibrillators: present but rare. Clin Res Cardiol. 2016;105:657–65.
Terada Y, Miyashita T, Nagamine Y, Goto T. A modified algorithm for choosing the most appropriate intraoperative pacemaker mode for patients with permanent pacemaker in non-cardiac surgery. J Anesth. 2021;35:145–9.
Suresh M, Benditt DG, Gold B, Joshi GP, Lurie KG. Suppression of cautery-induced electromagnetic interference of cardiac implantable electrical devices by closely spaced bipolar sensing. Anesth Analg. 2011;112:1358–61.
Neubauer H, Wellmann M, Herzog-Niescery J, Wutzler A, Weber TP, Mügge A, et al. Comparison of perioperative strategies in ICD patients: The perioperative ICD management study (PIM study). Pacing Clin Electrophysiol. 2018;41:1536–42.
Eldabe S, Buchser E, Duarte RV. Complications of spinal cord stimulation and peripheral nerve stimulation techniques: a review of the literature. Pain Med. 2015;17:325–36.
North RB, Parihar HS, Spencer SD, Spalding AF, Shipley J. Cost-effectiveness model shows superiority of wireless spinal cord stimulation implantation without a separate trial. Neuromodulation. 2021;24:596–603.
NDT is on the surgeon advisory board at Boston Scientific and is a consultant for Abbot Neuromodulation.
Conducted in accordance with the Allegheny Health Network Institutional Review Board, IRB #2022-250.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
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