Spinal Cord Stimulator Removal: Q&A with A Neurosurgeon

Spinal cord stimulation can be very beneficial for people suffering from chronic pain. However, not all patients will benefit. William S. Anderson, a neurosurgeon who specializes in functional Neurosurgery, including neuromodulation techniques discusses why some patients opt to reverse the procedure later.

What is the purpose of spinal cord stimulator removal?

Spinal cord stimulator removal (or a surgery to remove a spine cord stimulator) is performed to remove a device originally placed above the spinal chord to manage chronic pain.

Why have spinal cord stimulators been removed?

Anderson says that the most common reason to have a spinal cord stimulator removed is insufficient pain relief. Although surgeons try to achieve a minimum of 50% pain relief when implanting a spinal chord stimulator, there is no objective way to determine how much. We let patients choose whether or not to keep the device. Most people live with the stimulator for between two and three years before deciding to remove it.

What can go wrong with a spinal chord stimulator? How can you tell?

After being implanted for many years, a spinal cord stimulator can experience problems. There are many reasons this can happen, including failures in mechanical design, infections, and a general lack of effectiveness.

A spinal cord stimulator may not provide sufficient pain relief and could cause problems that require additional procedures to position or maintain the device. These problems could include:

Lead Migration

Your stimulator’s tingling sensation (often called paresthesias), will change to another part of your body if the leads (or the implants) move. Your device’s ability control pain can be reduced by this, making it feel worse.

Device Damage

The lead or pulse generator (battery packs) that is responsible for your paresthesias may break after a fall, trauma or normal wear and tear. Your stimulator will stop providing pain relief.

Rarely, the device may malfunction and cause pain or a sudden jolting sensation.

Infection

An infection around a spinal stimulator can lead to swelling, redness, pain, or discharge. It may also cause more general symptoms such as fever, delirium, or other complications. Infections are more common around the battery pack than the leads.

If you have any issues with your device, let your doctor know. Modern spinal cord stimulators are capable of transmitting diagnostic information wirelessly to enable your surgeons to diagnose mechanical and electrical problems remotely.

How can a spinal cord stimulator be removed?

The type of lead used to remove a spinal cord stimulator can affect the cost of surgery. The battery that powers the device and the leads that deliver the stimulation are the two main components of spinal cord stimulators.

There are two types of leads: percutaneous or paddle. Percutaneous leads can be inserted through the spine using an epidural needle. They are easier to remove and are less bulky. The paddle leads, on the other hand, are much larger and are usually attached to the spine column using a small amount of bone. Although they can still be removed, the process is more complicated.

It is not an easy task to remove these leads, particularly the larger ones. Anderson advises that it is best to have a skilled surgeon perform this procedure. After a paddle lead removal, you might need to stay a night at the hospital.

Percutaneous Leads for Spinal Cord Stimulator Removal

A surgeon will make a small incision along the spine to expose the area where percutaneous leads are located. Your surgeon will find the plastic anchors that hold percutaneous leads in place. This allows your surgeon to remove the device from the epidural area, which is the delicate space between the vertebrae, and the spinal cord.

After the leads have been removed, your surgeon will perform another incision to get rid of the implantable pulse generator. It is usually located in the lower back, buttocks, or both.

After the surgeon has removed the components, he closes the incisions. The procedure is completed.

It takes approximately an hour to perform the surgery. This is usually done while you are still under general anesthesia. Your surgeon may recommend local anesthesia that is less severe depending on your health.

Removal of Spinal Cord Stimulator: Paddle Leads

Surgeons incision the spine above the device to remove a spinal stimulator with paddle leads. This incision exposes the scar-capsule that was formed when the leads were first implanted.

The surgeon will open the capsule and carefully remove the leads. This is done without causing any damage to the spinal cord. Once the leads have been removed, the surgeon will disconnect the device from the rest of the wiring and then remove it. This might require drilling a small opening in the bone just above the spinal cord.

To remove the battery, the surgeon will make a second incision at the buttock or lower back.

The procedure takes approximately 2 1/2 hours. It is done under general anesthesia.

Removing Spinal Cord Stimulator

The recovery process for spinal cord stimulator removal takes place quickly. Patients spend one night in hospital to be monitored and then return home the following day.

Percutaneous leads are removed faster than those who had their paddle leads removed (around one day).

“For the most parts, I let my patients play it by ear. Anderson says that patients can return to work or physical activity once they feel better, but they will need to refrain from lifting more than 20 pounds for three weeks.

Complications of Spinal Cord Stimulator Removal

The chances of complications from spinal cord stimulator removals are very rare. They occur in about 2% to 3% of all procedures. To minimize the chance of complications, surgeons screen all patients. These include infection and cerebrospinal Fluid (CSF) leakage.

  • Infection is a possibility during any surgical procedure. Your care team will instruct you on how to keep your incisions clean before you leave the hospital.
  • CSF leaked can be caused by the surgeon opening the scar capsule around the larger paddle leads. This delicate area can be damaged by manipulating it. Some of the fluid may leak out of the dura (the outermost layer of your spinal cord). Although this is rarely life-threatening, it can often require additional surgery.

Spinal Cord Stimulator Removal: Pain Management

Patients who have had their stimulators removed must seek other treatments to manage chronic pain. These therapies could include:

  • Cognitive behavioral therapy (CBT: This is a type of psychotherapy that helps patients cope with chronic pain.
  • Chronic pain medication: Doctors are looking for more effective and less addictive drugs to treat chronic pain. Two types of medication have been shown to be effective:
    • Antidepressants: These drugs are used to treat depression. They alter the way nerve cells communicate with each other. The same mechanism can also alter the way that pain messages are transmitted.
    • Antiepileptics are used to prevent seizures, but they can also calm malfunctioning pain networks that send incorrect messages.

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