Exposed Hardware: A True Contraindication for a Spinal Cord Stimulator? A Case Report and Review of the Literature

BACKGROUND: Infection is one of the most common complications of spinal cord stimulator (SCS) implantation and causes severe morbidity for the patients and is costly for the health system and insurance. Every effort to minimize the risk of infection Post-SCS implantation has to be made. CASE REPORT: A 55-year-old man suffered right arm brachial plexus avulsion and subdural hematoma requiring a craniotomy and subsequently a cranioplasty with a metal mesh in 1998. Over the years he developed significant neuropathic pain which was controlled with a combination medication regimen until recently. In our clinic, a trial of cervical SCS showed significant improvement of pain. The consulting neurosurgeon, while evaluating his skull, noticed a very small skin defect, exposing a metal plate with no signs of infection. Based on that, he refused to implant the SCS. The patient is now seeking alternative treatment methods. CONCLUSION: Well-designed animal/human studies investigating the effects of exposed hardware for seeding infection to remote implants in the body are required to scientifically extrapolate if exposed hardware is a true contraindication for implanting an SCS or other devices in the body. KEY WORDS: Spinal cord stimulator, brachial plexus injury, complex regional pain syndrome, exposed hardware, surgical infection