Article
Complication rates of percutaneously implanted leads for Scs after a trial phase: 5-year follow-up
Search Medline for
Authors
-
Gregor Bara
- Neurochirurgische Klinik der Heinrich-Heine-Universität Düsseldorf, Düsseldorf
-
Stefan Schu
- Neurochirurgische Klinik der Heinrich-Heine-Universität Düsseldorf, Düsseldorf
-
Jaroslaw Maciaczyk
- Neurochirurgische Klinik der Heinrich-Heine-Universität Düsseldorf, Düsseldorf
-
Jan Vesper
- Neurochirurgische Klinik der Heinrich-Heine-Universität Düsseldorf, Düsseldorf
| Published: | June 2, 2015 |
|---|
Outline
Text
Objective: Spinal Cord Stimulation is an established treatment for various chronic pain syndromes. In general the percutaneous lead is placed first and being externalized. Upon successful trial with an external pulse generator, the IPG is implanted. The externalized lead may be a potential pathway for germs and cause infections. Infection rates of up to 22% have been reported. Further, migration rates of up to 30% have been reported for percutaneously implanted electrodes. Over the last years several sophisticated anchoring systems have become available. This study demonstrates infection and migration rates to be a minor complication in percutaneously implanted electrodes.
Method: Data was collected prospectively. The patients were implanted with hybrid lead using an Seldinger-style introduction system for percutaneous implantation and fixated with an anchoring system. All implantations were performed under local anesthesia. Prior to the final implantation of the implantable pulse generator, all patients underwent seven days of trial stimulation. 30 Minutes prior to surgery a single shot of Cefazolin has been given. The externalized lead was covered with a hydrocolloid dressing. During externalization and 5 days after IPG implantation patients were given Cefazolin 3x/d. Median follow-up was 36 months.
Results: 432 patients have been implanted so far. Infections requiring removal of the SCS system occurred in 2.0% (n=9). Rate of migration was 0.69% (n=3).
Conclusions: This study is the largest cohort of SCS patient studied for complication rates yet. With more indications emerging for SCS and more patients treated, sufficient data on complications becomes more important. Our rate of infection is lower than previously described in the literature. Strict asepsis, peri- and postoperative prophylactic antibiosis may reduce rate of infection efficiently. Further, our data shows percutaneously implanted electrodes in combination with an anchoring system to be very effective and less invasive than paddle type leads yet only minimally affected by lead migration.
