Spinal Cord Stimulator Related Infections: Findings From a Multicenter Retrospective Analysis of 2737 Implants

Markus A. Bendel, Travis O'Brien, Bryan C. Hoelzer, Timothy R. Deer, Thomas P. Pittelkow, Shrif Costandi, David R. Walega, Gerges Azer, Salim M. Hayek, Zhen Wang, Jason S. Eldrige, Wenchun Qu, Joshua M. Rosenow, Steven M. Falowski, Stephanie A. Neuman, Susan M. Moeschler, Catherine Wassef, Christopher Kim, Tariq Niazi, Taher SaifullahBrian Yee, Chong Kim, Christine L. Oryhan, Daniel T. Warren, Imanuel Lerman, Ruben Mora, Michael Hanes, Thomas Simopoulos, Sanjiv Sharma, Chris Gilligan, Warren Grace, Timothy Ade, Nagy A. Mekhail, John P. Hunter, Daniel Choi, Deborah Y. Choi

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Introduction: Surgical site infection is a potential complication of spinal cord stimulator (SCS) implantation. Current understanding of the epidemiology, diagnosis, and treatment of these infections is based largely on small clinical studies, many of which are outdated. Evidence-based guidelines for management of SCS-related infections thus rely instead on expert opinion, case reports, and case series. In this study, we aim to provide a large scale retrospective study of infection management techniques specifically for SCS implantation. Methods: A multicenter retrospective study of SCS implants performed over a seven-year period at 11 unique academic and non-academic institutions in the United States. All infections and related complications in this cohort were analyzed. Results: Within our study of 2737 SCS implant procedures, we identified all procedures complicated by infection (2.45%). Localized incisional pain and wound erythema were the most common presenting signs. Laboratory studies were performed in the majority of patients, but an imaging study was performed in less than half of these patients. The most common causative organism was Staphylococcus aureus and the IPG pocket was the most common site of an SCS-related infection. Explantation was ultimately performed in 52 of the 67 patients (77.6%). Non-explantation salvage therapy was attempted in 24 patients and was successful in resolving the infection in 15 patients without removal of SCS hardware components. Discussion: This study provides current data regarding SCS related infections, including incidence, diagnosis, and treatment.

Original languageEnglish (US)
Pages (from-to)553-557
Number of pages5
JournalNeuromodulation
Volume20
Issue number6
DOIs
StatePublished - Jan 1 2017

Fingerprint

Spinal Cord
Infection
Retrospective Studies
Surgical Wound Infection
Salvage Therapy
Expert Testimony
Erythema
Multicenter Studies
Staphylococcus aureus
Epidemiology
Guidelines
Pain
Incidence
Wounds and Injuries
Therapeutics

Keywords

  • Complication
  • infection
  • spinal cord stimulation
  • treatment

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Bendel, M. A., O'Brien, T., Hoelzer, B. C., Deer, T. R., Pittelkow, T. P., Costandi, S., ... Choi, D. Y. (2017). Spinal Cord Stimulator Related Infections: Findings From a Multicenter Retrospective Analysis of 2737 Implants. Neuromodulation, 20(6), 553-557. https://doi.org/10.1111/ner.12636

Spinal Cord Stimulator Related Infections : Findings From a Multicenter Retrospective Analysis of 2737 Implants. / Bendel, Markus A.; O'Brien, Travis; Hoelzer, Bryan C.; Deer, Timothy R.; Pittelkow, Thomas P.; Costandi, Shrif; Walega, David R.; Azer, Gerges; Hayek, Salim M.; Wang, Zhen; Eldrige, Jason S.; Qu, Wenchun; Rosenow, Joshua M.; Falowski, Steven M.; Neuman, Stephanie A.; Moeschler, Susan M.; Wassef, Catherine; Kim, Christopher; Niazi, Tariq; Saifullah, Taher; Yee, Brian; Kim, Chong; Oryhan, Christine L.; Warren, Daniel T.; Lerman, Imanuel; Mora, Ruben; Hanes, Michael; Simopoulos, Thomas; Sharma, Sanjiv; Gilligan, Chris; Grace, Warren; Ade, Timothy; Mekhail, Nagy A.; Hunter, John P.; Choi, Daniel; Choi, Deborah Y.

In: Neuromodulation, Vol. 20, No. 6, 01.01.2017, p. 553-557.

Research output: Contribution to journalArticle

Bendel, MA, O'Brien, T, Hoelzer, BC, Deer, TR, Pittelkow, TP, Costandi, S, Walega, DR, Azer, G, Hayek, SM, Wang, Z, Eldrige, JS, Qu, W, Rosenow, JM, Falowski, SM, Neuman, SA, Moeschler, SM, Wassef, C, Kim, C, Niazi, T, Saifullah, T, Yee, B, Kim, C, Oryhan, CL, Warren, DT, Lerman, I, Mora, R, Hanes, M, Simopoulos, T, Sharma, S, Gilligan, C, Grace, W, Ade, T, Mekhail, NA, Hunter, JP, Choi, D & Choi, DY 2017, 'Spinal Cord Stimulator Related Infections: Findings From a Multicenter Retrospective Analysis of 2737 Implants', Neuromodulation, vol. 20, no. 6, pp. 553-557. https://doi.org/10.1111/ner.12636
Bendel, Markus A. ; O'Brien, Travis ; Hoelzer, Bryan C. ; Deer, Timothy R. ; Pittelkow, Thomas P. ; Costandi, Shrif ; Walega, David R. ; Azer, Gerges ; Hayek, Salim M. ; Wang, Zhen ; Eldrige, Jason S. ; Qu, Wenchun ; Rosenow, Joshua M. ; Falowski, Steven M. ; Neuman, Stephanie A. ; Moeschler, Susan M. ; Wassef, Catherine ; Kim, Christopher ; Niazi, Tariq ; Saifullah, Taher ; Yee, Brian ; Kim, Chong ; Oryhan, Christine L. ; Warren, Daniel T. ; Lerman, Imanuel ; Mora, Ruben ; Hanes, Michael ; Simopoulos, Thomas ; Sharma, Sanjiv ; Gilligan, Chris ; Grace, Warren ; Ade, Timothy ; Mekhail, Nagy A. ; Hunter, John P. ; Choi, Daniel ; Choi, Deborah Y. / Spinal Cord Stimulator Related Infections : Findings From a Multicenter Retrospective Analysis of 2737 Implants. In: Neuromodulation. 2017 ; Vol. 20, No. 6. pp. 553-557.
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T2 - Findings From a Multicenter Retrospective Analysis of 2737 Implants

AU - Bendel, Markus A.

AU - O'Brien, Travis

AU - Hoelzer, Bryan C.

AU - Deer, Timothy R.

AU - Pittelkow, Thomas P.

AU - Costandi, Shrif

AU - Walega, David R.

AU - Azer, Gerges

AU - Hayek, Salim M.

AU - Wang, Zhen

AU - Eldrige, Jason S.

AU - Qu, Wenchun

AU - Rosenow, Joshua M.

AU - Falowski, Steven M.

AU - Neuman, Stephanie A.

AU - Moeschler, Susan M.

AU - Wassef, Catherine

AU - Kim, Christopher

AU - Niazi, Tariq

AU - Saifullah, Taher

AU - Yee, Brian

AU - Kim, Chong

AU - Oryhan, Christine L.

AU - Warren, Daniel T.

AU - Lerman, Imanuel

AU - Mora, Ruben

AU - Hanes, Michael

AU - Simopoulos, Thomas

AU - Sharma, Sanjiv

AU - Gilligan, Chris

AU - Grace, Warren

AU - Ade, Timothy

AU - Mekhail, Nagy A.

AU - Hunter, John P.

AU - Choi, Daniel

AU - Choi, Deborah Y.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Introduction: Surgical site infection is a potential complication of spinal cord stimulator (SCS) implantation. Current understanding of the epidemiology, diagnosis, and treatment of these infections is based largely on small clinical studies, many of which are outdated. Evidence-based guidelines for management of SCS-related infections thus rely instead on expert opinion, case reports, and case series. In this study, we aim to provide a large scale retrospective study of infection management techniques specifically for SCS implantation. Methods: A multicenter retrospective study of SCS implants performed over a seven-year period at 11 unique academic and non-academic institutions in the United States. All infections and related complications in this cohort were analyzed. Results: Within our study of 2737 SCS implant procedures, we identified all procedures complicated by infection (2.45%). Localized incisional pain and wound erythema were the most common presenting signs. Laboratory studies were performed in the majority of patients, but an imaging study was performed in less than half of these patients. The most common causative organism was Staphylococcus aureus and the IPG pocket was the most common site of an SCS-related infection. Explantation was ultimately performed in 52 of the 67 patients (77.6%). Non-explantation salvage therapy was attempted in 24 patients and was successful in resolving the infection in 15 patients without removal of SCS hardware components. Discussion: This study provides current data regarding SCS related infections, including incidence, diagnosis, and treatment.

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