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

IF 0.7 Q4 CLINICAL NEUROLOGY
Jordan N Norris, Nathan Esplin, Rosh Bharthi, Michael Patterson, Nestor D Tomycz
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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.

脊髓刺激器植入脉冲发生器在择期手术后失活:一个认识不足的问题。
研究设计:我们回顾性分析了由一名外科医生(NDT)植入的用于脊髓刺激(SCS)的植入式脉冲发生器(IPG)数据库。此外,我们还报告了五例典型患者的系列病例:SCS IPG 的电子元件在植入患者接受手术时很容易损坏。有些 SCS 有专门的手术模式,有些则建议关闭 SCS 以防止其受损。IPG 失活可能需要重置或更换手术。我们的目的是探索这一尚未研究过的现实问题的普遍性:地点:宾夕法尼亚州匹兹堡:利用单个外科医生 SCS 数据库,我们确定了非 SCS 手术后 IPG 失活的病例,并分析了处理方法。然后,我们查看了五个典型病例的病历:结果:在 2016-2022 年间植入的 490 例 SCS IPG 中,有 15 例(3%)患者的 IPG 在另一次非 SCS 手术后失活。12例(80%)需要手术更换IPG,3例(20%)通过非手术恢复了IPG功能。在迄今为止分析的病例中,手术模式通常在手术前未被激活:结论:手术导致 SCS IPG 失活并非罕见问题,可能是由单极电烧引起的。过早进行 IPG 更换手术会带来风险,并降低 SCS 的成本效益。对这一问题的认识可能会促使外科医生、患者和护理人员采取更多预防措施,并鼓励技术进步,使 IPG 不易受手术工具的影响。要确定哪些质量改进措施可以防止 IPG 受到电损伤,还需要进一步的研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Spinal Cord Series and Cases
Spinal Cord Series and Cases Medicine-Neurology (clinical)
CiteScore
2.20
自引率
8.30%
发文量
92
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