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Manjunath A, Goel C, Baskaran AB, Kozel OA, Gibson W, Jones M, Rosenow JM. Spinal cord stimulation-induced gastroparesis: A case report. Surg Neurol Int 2023; 14:250. [PMID: 37560564 PMCID: PMC10408636 DOI: 10.25259/sni_1133_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 06/29/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Spinal cord stimulation (SCS) involves the utilization of an implantable neurostimulation device, stereotypically used in the treatment of patients with chronic neuropathic pain. While these devices have been shown to have significant clinical benefits, there have also been documented potential complications, including the risk of infection, fractured electrodes, electrode migration, and lack of symptom improvement. In addition, there has been minimal documentation on gastrointestinal (GI) side effects after SCS implantation. CASE DESCRIPTION A 42-year-old patient with chronic axial and radicular neuropathic pain in her back and left leg status post multiple lumbar surgeries underwent implantation of an open paddle lead in the T8-T9 region. After the procedure, the patient endorsed a 50% decrease in pain at the 6-week follow-up with no further concerns. However, at the 18 months follow-up, the patient endorsed severe constipation when the SCS was turned on, leading to subsequent evaluation by gastroenterology, motility studies, and a thorough bowel regimen. Symptoms persisted, and the patient ultimately opted for the removal of the SCS implant at 21 months after the initial surgery. CONCLUSION While the exact mechanism behind the GI side effects endorsed in this patient is unknown, current literature postulates a variety of theories, including a SCS-induced parasympathetic blockade of the GI tract. Further, investigation is needed to determine the exact effects of SCS on the GI tract.
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Affiliation(s)
- Anusha Manjunath
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, United States
| | - Chirag Goel
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, United States
| | - Archit Bharathwaj Baskaran
- Department of Internal Medicine, The University of Chicago Pritzker School of Medicine, Chicago, United States
| | - Olivia A. Kozel
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - William Gibson
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, United States
| | - Michael Jones
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, United States
| | - Joshua M. Rosenow
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, United States
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Lam CM, Latif U, Sack A, Govindan S, Sanderson M, Vu DT, Smith G, Sayed D, Khan T. Advances in Spinal Cord Stimulation. Bioengineering (Basel) 2023; 10:185. [PMID: 36829678 PMCID: PMC9951889 DOI: 10.3390/bioengineering10020185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/17/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
Neuromodulation, specifically spinal cord stimulation (SCS), has become a staple of chronic pain management for various conditions including failed back syndrome, chronic regional pain syndrome, refractory radiculopathy, and chronic post operative pain. Since its conceptualization, it has undergone several advances to increase safety and convenience for patients and implanting physicians. Current research and efforts are aimed towards novel programming modalities and modifications of existing hardware. Here we review the recent advances and future directions in spinal cord stimulation including a brief review of the history of SCS, SCS waveforms, new materials for SCS electrodes (including artificial skins, new materials, and injectable electrodes), closed loop systems, and neurorestorative devices.
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Affiliation(s)
- Christopher M. Lam
- Department of Anesthesiology and Pain Medicine, University of Kansas Health System, Kansas City, KS 66160, USA
| | - Usman Latif
- Department of Anesthesiology and Pain Medicine, University of Kansas Health System, Kansas City, KS 66160, USA
| | - Andrew Sack
- Department of Anesthesiology and Pain Medicine, University of Kansas Health System, Kansas City, KS 66160, USA
| | - Susheel Govindan
- Department of Anesthesiology and Pain Medicine, University of Kansas Health System, Kansas City, KS 66160, USA
| | - Miles Sanderson
- Department of Anesthesiology and Pain Medicine, University of Kansas Health System, Kansas City, KS 66160, USA
| | - Dan T. Vu
- Department of Anesthesiology and Pain Medicine, University of Kansas Health System, Kansas City, KS 66160, USA
| | - Gabriella Smith
- School of Medicine, University of Kansas, Kansas City, KS 66160, USA
| | - Dawood Sayed
- Department of Anesthesiology and Pain Medicine, University of Kansas Health System, Kansas City, KS 66160, USA
| | - Talal Khan
- Department of Anesthesiology and Pain Medicine, University of Kansas Health System, Kansas City, KS 66160, USA
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Brown A, Mandelberg NJ, Munoz-Mendoza D, Palys V, Schalock PC, Mogilner A, North R, A Petersen E. Allergy Considerations in Implanted Neuromodulation Devices. Neuromodulation 2021; 24:1307-1316. [PMID: 33428821 DOI: 10.1111/ner.13332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/24/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Allergic reactions are rare and poorly understood complications of neuromodulation device implantation. There are currently no guidelines for management of allergic reactions to these devices and their components. Here we review the published cases of allergic reactions to implanted neuromodulatory devices and leverage the experiences of other specialties that deal with similar complications to formulate recommendations for prevention and management. MATERIALS AND METHODS A review and assessment of the literature. RESULTS Allergic reactions to a number of implantable devices have been observed and published. In dentistry and orthopedics, metals such as nickel are the most frequent cause of allergic reactions. In interventional cardiology, where devices closely resemble neuromodulatory devices, titanium, silicone, and polyurethanes are the most common causes of allergic reactions. In neurosurgery, allergic reactions to implantable neuromodulatory devices are rare, and we summarize 13 cases published to date. Such allergic reactions generally present as local dermatitis, erythema, and pruritus, which can be difficult to distinguish from surgical site infection. In one published case, symptoms resolved with corticosteroid treatment, but all other cases required explantation. The successful reimplantation with a modified device was reported in some cases. CONCLUSIONS Patients should be screened for a personal history of contact allergy before implantation procedures. A multidisciplinary approach to suspected cases of postoperative allergic reactions involving collaboration between neurosurgeons and other implanting physicians, dermatologists or allergists, and device manufacturers is recommended. In cases where an allergic reaction is suspected, an infectious etiology should be ruled out first. Clinical suspicion can then be supported with the use of patch testing, interpreted by an experienced dermatologist or allergist. If patch testing supports an allergic etiology, the implanting physician and the device manufacturer can work together to modify the device for safe reimplantation.
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Affiliation(s)
- Austin Brown
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Diana Munoz-Mendoza
- Division of Pediatric Allergy, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA
| | - Viktoras Palys
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Peter C Schalock
- Department of Dermatology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Alon Mogilner
- Department of Neurosurgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Richard North
- The Institute of Neuromodulation, Chicago, IL, USA.,The Neuromodulation Foundation, Baltimore, MD, USA.,The Johns Hopkins University School of Medicine (ret.), Baltimore, MD, USA
| | - Erika A Petersen
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Dupré DA, Tomycz N, Whiting D, Oh M. Spinal Cord Stimulator Explantation: Motives for Removal of Surgically Placed Paddle Systems. Pain Pract 2017; 18:500-504. [DOI: 10.1111/papr.12639] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/25/2017] [Accepted: 08/31/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Derrick A. Dupré
- Department of Neurosurgery; Allegheny General Hospital; Pittsburgh Pennsylvania U.S.A
| | - Nestor Tomycz
- Department of Neurosurgery; Allegheny General Hospital; Pittsburgh Pennsylvania U.S.A
| | - Donald Whiting
- Department of Neurosurgery; Allegheny General Hospital; Pittsburgh Pennsylvania U.S.A
| | - Michael Oh
- Department of Neurosurgery; Allegheny General Hospital; Pittsburgh Pennsylvania U.S.A
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Deer TR, Mekhail N, Provenzano D, Pope J, Krames E, Thomson S, Raso L, Burton A, DeAndres J, Buchser E, Buvanendran A, Liem L, Kumar K, Rizvi S, Feler C, Abejon D, Anderson J, Eldabe S, Kim P, Leong M, Hayek S, McDowell G, Poree L, Brooks ES, McJunkin T, Lynch P, Kapural L, Foreman RD, Caraway D, Alo K, Narouze S, Levy RM, North R. The appropriate use of neurostimulation: avoidance and treatment of complications of neurostimulation therapies for the treatment of chronic pain. Neuromodulation Appropriateness Consensus Committee. Neuromodulation 2015; 17:571-97; discussion 597-8. [PMID: 25112891 DOI: 10.1111/ner.12206] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 11/24/2013] [Accepted: 12/14/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The International Neuromodulation Society (INS) has determined that there is a need for guidance regarding safety and risk reduction for implantable neurostimulation devices. The INS convened an international committee of experts in the field to explore the evidence and clinical experience regarding safety, risks, and steps to risk reduction to improve outcomes. METHODS The Neuromodulation Appropriateness Consensus Committee (NACC) reviewed the world literature in English by searching MEDLINE, PubMed, and Google Scholar to evaluate the evidence for ways to reduce risks of neurostimulation therapies. This evidence, obtained from the relevant literature, and clinical experience obtained from the convened consensus panel were used to make final recommendations on improving safety and reducing risks. RESULTS The NACC determined that the ability to reduce risk associated with the use of neurostimulation devices is a valuable goal and possible with best practice. The NACC has recommended several practice modifications that will lead to improved care. The NACC also sets out the minimum training standards necessary to become an implanting physician. CONCLUSIONS The NACC has identified the possibility of improving patient care and safety through practice modification. We recommend that all implanting physicians review this guidance and consider adapting their practice accordingly.
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Scranton RA, Skaribas IM, Simpson RK. Spinal stimulator peri-electrode masses: case report. J Neurosurg Spine 2015; 22:70-4. [PMID: 25380541 DOI: 10.3171/2014.10.spine1425] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors describe a case of delayed spastic quadriparesis caused by a peri-electrode mass following the implantation of a minimally invasive percutaneous spinal cord stimulator (SCS). Prior reports with paddle-type electrodes are reviewed, and a detailed histological and pathophysiological comparison with the present case is made. The patient developed tolerance to a cervical percutaneous SCS 4 months after implantation, followed by the onset of spastic quadriparesis 9 months after implantation. The stimulator was removed, and contrast-enhanced MRI revealed an enhancing epidural mass where the system had been placed, with severe spinal cord compression. Decompression was carried out, and the patient experienced neurological improvement. Pathological examination revealed fibrotic tissue with granulomatous and multinucleated giant cell reactions. No evidence of infection or hemorrhage was found. Professionals treating patients with SCSs or contemplating their insertion should be aware of this delayed complication and associated risk factors.
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Affiliation(s)
- Robert A Scranton
- Department of Neurosurgery, Houston Methodist Neurological Institute; and
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Chaudhry ZA, Najib U, Bajwa ZH, Jacobs WC, Sheikh J, Simopoulos TT. Detailed analysis of allergic cutaneous reactions to spinal cord stimulator devices. J Pain Res 2013; 6:617-23. [PMID: 23946668 PMCID: PMC3738259 DOI: 10.2147/jpr.s44676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The use of spinal cord stimulation (SCS) devices to treat chronic, refractory neuropathic pain continues to expand in application. While device-related complications have been well described, inflammatory reactions to the components of these devices remain underreported. In contrast, hypersensitivity reactions associated with other implanted therapies, such as endovascular and cardiac rhythm devices, have been detailed. The purpose of this case series is to describe the clinical presentation and course of inflammatory reactions as well as the histology of these reactions. All patients required removal of the entire device after developing inflammatory reactions over a time course of 1-3 months. Two patients developed a foreign body reaction in the lead insertion wound as well as at the implantable pulse generator site, with histology positive for giant cells. One patient developed an inflammatory dermatitis on the flank and abdomen that resolved with topical hydrocortisone. "In vivo" testing with a lead extension fragment placed in the buttock resulted in a negative reaction followed by successful reimplantation of an SCS device. Inflammatory reactions to SCS devices can manifest as contact dermatitis, granuloma formation, or foreign body reactions with giant cell formation. Tissue diagnosis is essential, and is helpful to differentiate an inflammatory reaction from infection. The role of skin patch testing for 96 hours may not be suited to detect inflammatory giant cell reactions that manifest several weeks post implantation.
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Affiliation(s)
- Zeshan Ahmed Chaudhry
- Department of Diagnostic and Interventional Neuroradiology, Massachusetts General Hospital/ Harvard Medical School, Boston, MA, USA
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Taverner MG. A Case of an Allergic Reaction to a Spinal Cord Stimulator: Identification of the Antigen With Epicutaneous Patch Testing, Allowing Successful Reimplantation. Neuromodulation 2013; 16:595-9. [DOI: 10.1111/ner.12049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 01/20/2013] [Accepted: 01/28/2013] [Indexed: 10/27/2022]
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Gadgil N, Burton AW, Viswanathan A. Treatment of contact dermatitis associated with spinal cord stimulator pulse generator--technical note. Neuromodulation 2012. [PMID: 23205881 DOI: 10.1111/ner.12001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Expanded polytetrafluoroethylene sheets have been successfully used as a biologic barrier in the treatment of pacemaker contact dermatitis. TECHNIQUE In this report, we describe two patients with contact dermatitis related to the implantable pulse generator of a spinal cord stimulator who were treated with expanded polytetrafluoroethylene as a barrier. RESULTS Resolution of the dermatitis was achieved in both cases. CONCLUSIONS This technique is an effective way of treating contact dermatitis related to implantable pulse generators, without the need for explantation of the neuromodulation system.
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Affiliation(s)
- Nisha Gadgil
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
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Abstract
STUDY DESIGN Case report. OBJECTIVE To report the occurrence of a rare complication following revision of a spinal cord stimulator. SUMMARY OF BACKGROUND DATA Puncture of the dura with placement of an electrode within the spinal cord has not been reported as a complication of spinal cord stimulation. METHODS A patient presented with upper and lower extremity weakness following inadvertent placement of an electrode into the spinal cord. The clinical case is presented as well as review of the literature. RESULTS The patient had the electrode successfully removed; however, her neurologic status deteriorated. CONCLUSION Revision of spinal cord stimulators is usually a safe procedure. However, placement of an electrode within the spinal cord during the revision process is a potential complication resulting in severe neurologic injury.
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Shuster J. Adverse Reaction without Drug Absorption; Allergic Reaction to Spinal Cord Stimulator; Interferon Beta-1b and Hypothyroidism; Priapism with Sildenafil Citrate; Chest and Back Pain Associated with Liposomal Daunorubicin; Interaction between Warfarin and Trazodone. Hosp Pharm 2000. [DOI: 10.1177/001857870003500909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to promote reporting of ADRs to the FDA's medWatch program (1-800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
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Affiliation(s)
- Joel Shuster
- Temple University School of Pharmacy, Philadelphia; Medical College of Pennsylvania Hospital, Philadelphia; and Institute for Safe Medication Practices, Huntingdon Valley, PA
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