scholarly journals Unexpected extrusion of the implantable pulse generator of the spinal cord stimulator - A case report -

2021 ◽  
Vol 16 (1) ◽  
pp. 103-107
Author(s):  
Eun-Ji Choi ◽  
Hyun-Su Ri ◽  
Hyeonsoo Park ◽  
Hye-Jin Kim ◽  
Ji-Uk Yoon ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Pulse Generator ◽  
Pain Syndrome ◽  
Lower Abdomen ◽  
Local Pain ◽  
Implantable Pulse Generator ◽  
Technological Advances ◽  
Pressure Necrosis ◽  
The Right ◽  
Car Accident

Background: Despite significant technological advances in the implantable pulse generator (IPG), complications can still occur. We report a case that unexpected extrusion of the IPG of spinal cord stimulation (SCS) was promptly identified and successfully removed without any complications. Case: After a car accident 4 years ago, a 55-year-old man who was diagnosed with complex local pain syndrome in his right leg. The SCS was inserted with 2 leads, with the IPG being implanted in the right lower abdomen region. Four years later, he developed extrusion of the IPG from his abdominal region. This unexpected extrusion may have been related to pressure necrosis caused by continued compression of pocket site where a belt was frequently tied. The IPG and the leads were successfully removed without infection occurring. Conclusions: To prevent unexpected extrusion of IPG, it is necessary to consider in advance whether the pocket site is pressed against the belt.

scholarly journals Dorsal root ganglion stimulation for treatment of complex regional pain syndrome of the foot

2020 ◽  
Vol 3 (2) ◽  
pp. V8
Author(s):  
Kevin Hines ◽  
Fadi Al Saiegh ◽  
Aria Mahtabfar ◽  
Kavantissa M. Keppetipola ◽  
Caio M. Matias ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Dorsal Root Ganglion ◽  
Complex Regional Pain Syndrome ◽  
Spinal Cord Stimulation ◽  
Dorsal Root ◽  
Pain Syndrome ◽  
Thoracic Spinal Cord ◽  
Plantar Aspect ◽  
Thoracic Spinal ◽  
The Right

This is a case of a 54-year-old man presenting with complex regional pain syndrome (CRPS) type 1 of the right lower extremity, which was most debilitating in the plantar aspect of the right foot. The patient had prior treatment with thoracic spinal cord stimulation; however, the foot pain remained intractable. Given that his pain was predominantly in his foot and remained debilitating despite thoracic spinal cord stimulation, it was recommended that the patient undergo a trial of dorsal root ganglion (DRG) stimulation. The surgical technique for placement of dorsal root ganglion stimulators is demonstrated in this operative video.The video can be found here: https://youtu.be/_1xMxFZa6tU

scholarly journals Сlinical Case of Successful Lumbar Sympathectomy in the Treatment of Complex Regional Pain Syndrome

2020 ◽  
Vol 9 (1) ◽  
pp. 136-139
Author(s):  
A. N. Ryazanov ◽  
I. D. Magamedov ◽  
V. V. Soroka ◽  
S. P. Nokhrin ◽  
E. P. Mikhelson ◽  
...  
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Complete Relief ◽  
Therapeutic Effects ◽  
Lumbar Sympathectomy ◽  
Relevant Today ◽  
The Right ◽  
Car Accident ◽  
Traumatic Damage

ABSTRACT. A 53-year-old male patient had extensive traumatic damage to the right lower limb in a car accident that happened 17 years ago, which subsequently led to a large amputation at the hip level. Later, adduction contracture in the right hip joint with a complex regional pain syndrome developed. Due to the ineffectiveness of various methods of conservative treatment, it was decided to perform right-sided lumbar sympathectomy. Ten days later, the patient was discharged for outpatient treatment. The result of the operation was a complete relief of pain syndrome both in the early postoperative and in the long-term periods of time. Despite the large number of types of conservative therapy in modern clinical practice, none of them is perfect. Doctors decide to operate less often, trying to minimize the intervention. However, therapeutic effects are not always possible as monotherapy, often requiring additional treatments. Due to the wide development and distribution of medical products, doctors often neglect or forget about such a method as lumbar sympathectomy. Therefore, the problem of complex regional pain syndrome remains relevant today.

Implantable Pulse Generator Site May Be Associated With Spinal Cord Stimulation Revision Surgeries

2019 ◽  
Author(s):  
Shyle H. Mehta ◽  
Christian M. Hoelscher ◽  
Ashwini D. Sharan ◽  
Sara Thalheimer ◽  
Chengyuan Wu
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Pulse Generator ◽  
Implantable Pulse Generator

Abdominal pain: finding the cause and selecting tactics

2021 ◽  
pp. 26-32
Author(s):  
Roman Petrovich Stepchenkov
Keyword(s):  
Abdominal Pain ◽  
Digestive System ◽  
Correct Diagnosis ◽  
Family Doctor ◽  
Pain Syndrome ◽  
Lower Abdomen ◽  
Family Doctors ◽  
Genitourinary System ◽  
The Family ◽  
The Right

Abdominal pain is one of the most common symptoms that family doctors have to deal with in their practice. In the vast majority of cases, the patient considers abdominal pain to be the sign of a disturbance in the digestive system; however, in fact, any organ — the spleen, bladder, organs of the genitourinary system, and sometimes even the heart — can be the «culprit» causing the pain syndrome. Therefore, the family doctor is often faced with a rather difficult task — to carry out a differential diagnosis of abdominal pain and choose the right tactics for further treatment. By its nature, the pain can be acute and chronic, associated or not associated with food intake, arising periodically, having a cramping character or constant. Depending on the localization, it is divided into pain in the epigastric region, pain in the middle and lower abdomen. Often it is the localization of pain that helps to make the correct diagnosis.

scholarly journals Immediate Return to Ambulation and Improved Functional Capacity for Rehabilitation in Complex Regional Pain Syndrome following Early Implantation of a Spinal Cord Stimulation System

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Brandon Jesse Goff ◽  
Jeremy Wingseng Naber ◽  
John Patrick McCallin ◽  
Edward Michael Lopez ◽  
Kevin Brant Guthmiller ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Complex Regional Pain Syndrome ◽  
Functional Capacity ◽  
Spinal Cord Stimulation ◽  
Pain Syndrome ◽  
Cervical Disc ◽  
Rapid Progression ◽  
Pharmacological Management ◽  
Stimulation System ◽  
The Right

Complex regional pain syndrome (CRPS) is a neuropathic pain condition that is characterized by vasomotor, sensory, sudomotor, and motor symptoms. Spinal cord stimulation (SCS) has been successfully utilized for the treatment of pain refractory to conventional therapies. We present a case of a previously highly functioning 54-year-old female who developed a rarely reported case of idiopathic CRPS of the right ankle which spontaneously occurred four months after an uncomplicated anterior cervical disc fusion. This condition resulted in severe pain and functional impairment that was unresponsive to pharmacological management. The patient’s rehabilitation was severely stymied by her excruciating pain. However, with the initiation of spinal cord stimulation, her pain was adequately controlled allowing for progression to full unassisted ambulation, advancing functional capacity, and improving quality of life. This case report supports the concept that rapid progression to neuromodulation, rather than delays that occur due to attempts at serial sympathetic blocks, may better control symptoms leading allowing for a more meaningful recovery.

scholarly journals Late Extrusion of an Implantable Pulse Generator of a Spinal Cord Stimulator

2015 ◽  
Vol 4;19 (4;5) ◽  
pp. E671-E674
Author(s):  
Joseph Rabi
Keyword(s):  
Spinal Cord ◽  
Pulse Generator ◽  
Rare Complication ◽  
Late Complication ◽  
Gluteal Region ◽  
Spinal Cord Stimulator ◽  
Key Words Spinal Cord ◽  
Implantable Pulse Generator ◽  
Failed Back Syndrome ◽  
History Of

The objective of this manuscript was to report a case of a patient with extruded pulse generator 3 years after implantation of a spinal cord stimulator system. With the increasing incidence of chronic pain, spinal cord stimulation (SCS) is becoming more commonly utilized by pain physicians. SCS is a generally safe intervention with minimal adverse effects; however, there are risks of complications which practitioners should be aware of prior to and after placement of the SCS. We present a case of a patient with a late complication of extrusion of an implantable pulse generator (IPG) of a SCS that was promptly identified and successfully removed without any complications. A 60-year-old male truck driver with history of failed back syndrome and diabetes underwent a SCS system implanted with excellent relief of his pain. The SCS was implanted with 2 leads with the IPG being sutured 3 cm in depth in the superior gluteal region. Three years after the implantation, he developed pain over the site of the generator and presented to our clinic with extrusion of the non-rechargeable pulse generator from his gluteal region. The pulse generator was successfully removed with the battery not being infected. This late complication may have been related to his ongoing profession of daily driving with pressure necrosis from prolonged sitting and constant vibration during long rides associated. Structural size and design of the pulse generator may have had an important contribution as well. To our knowledge this complication has not been reported in the literature. Physicians that place or manage patients with SCSs should be aware of this rare complication and maintain vigilance even after remote implantation of the SCS systems. Key words: Spinal cord stimulator, complication, extrusion, implantable pulse generator, neuromodulation, failed back syndrome, battery complication

scholarly journals Evaluation of Interaction between a Spinal Cord Stimulator and Implanted CardioverterDefibrillator in a Swine Model

2013 ◽  
Vol 5;16 (5;9) ◽  
pp. 489-496
Author(s):  
Gassan M. Chaiban
Keyword(s):  
Spinal Cord ◽  
Right Ventricle ◽  
Epidural Space ◽  
Pulse Generator ◽  
Swine Model ◽  
Boston Scientific ◽  
Spinal Cord Stimulator ◽  
Electrode Lead ◽  
Chronic Pain Conditions ◽  
The Right

Background: Spinal cord stimulators (SCS) have been used for many years to treat a myriad of chronic pain conditions using electrical signals to diminish the perception of a painful stimulus. Because of the electrical nature of the devices, there is a concern about the potential for electromagnetic interaction between the device and lifesaving cardiac implantable cardiovertersdefibrillators (ICVD). Objective: The purpose of this study was to use a swine model to evaluate the potential for interaction between an implanted SCS and ICVD using the closest possible proximity, highest stimulation settings, and most sensitive ICVD settings. Methods: A pig was anesthetized and subsequently an ICVD and ICVD lead (Cogni 100-D and Endotak Reliance®, Boston Scientific, Natick, MA) were placed into the right prepectoral region and the right ventricle, respectively. An SCS (50 cm linear ST Precision Plu octad electrode lead [Boston Scientific, Valencia, CA] with 3 mm wide contacts spaced one mm apart) was implanted using fluoroscopic guidance into the posterior epidural space. Remote interrogation and programming of the ICVD were performed while the SCS lead was placed in as close proximity as possible, using fluoroscopy to guide the final position of the SCS electrode. After confirming that both systems were working, appropriately 9 stimulating configurations of varying current, pulse width, and frequency, including maximal settings, were delivered through the SCS. The effects on the ICVD were recorded at 2 sensitivity settings. Results: None of the tested SCS configurations caused interference with the proper functioning of the ICVD. Limitations: The anatomical proximity of the posterior epidural space and right ventricle of the swine is different from humans. While the entire pacer, including generator, was imbedded in a subcutaneous pocket, an implantable pulse generator for the SCS was not implanted, which did not allow us to study if any damage or a resetting of settings had occurred to the generator. Only one manufacturer was used in this study. Also, this study was performed in an anesthetized pig and the anatomical positions remained static. Realistically, changes in position of the devices would occur in patients who perform activities of daily living, and this can potentially shorten the distance between the 2 leads causing adverse interaction. Conclusion: This study clearly demonstrated the feasibility of the 2 devices coexisting and functioning appropriately in an animal model using an ICVD and SCS donated by Boston Scientific. Further studies are needed to elucidate restrictions, optimal settings and parameters in a human setting. Key words: Spinal cord stimulator, interaction, implantable cardioverter defibrillator, pacemaker, swine model, cross-talk.

Spinal cord stimulation: Background and clinical application

2014 ◽  
Vol 5 (3) ◽  
pp. 175-181 ◽  
Author(s):  
Kaare Meier
Keyword(s):  
Spinal Cord ◽  
Clinical Application ◽  
Spinal Cord Stimulation ◽  
Pulse Generator ◽  
Pain Syndrome ◽  
Theoretical Background ◽  
Historical Background ◽  
Implantation Technique ◽  
Success Rates ◽  
Failed Back Surgery

AbstractBackgroundSpinal cord stimulation (SCS) is a surgical treatment for chronic neuropathic pain refractory to conventional treatment. SCS treatment consists of one or more leads implanted in the epidural space of the spinal canal, connected to an implantable pulse generator (IPG). Each lead carries a number of contacts capable of delivering a weak electrical current to the spinal cord, evoking a feeling of peripheral paresthesia. With correct indication and if implanted by an experienced implanter, success rates generally are in the range of about 50–75%.Common indications include complex regional pain syndrome (CRPS I), angina pectoris, and radicular pain after failed back surgery syndrome, and the treatment is also used to treat stump pain after amputation, and pain due to peripheral nerve injury, peripheral vascular disease, and diabetic neuropathy.Recommended contraindications for the treatment include pregnancy, coagulopathy, severe addiction to psychoactive substances, and lack of ability to cooperate (e.g. due to active psychosis or cognitive impairment). Most common complications to the treatment include lead migration, lead breakage, infection, pain over the implant, and dural puncture.Despite extensive research in the area, the mechanisms of action are still only partially understood.MethodsIn this topical review the historical background behind the treatment is described and the current theories on the mechanism of action are presented. The implantation procedure is described in detail and illustrated with a series of intraoperative pictures. Finally, indications for SCS are discussed along with some of the controversies surrounding the therapy.ImplicationsThe reader is presented with a broad overview of spinal cord stimulation, including the historical and theoretical background, practical implantation technique, and clinical application.

scholarly journals Significant cephalad lead migration with use of externally powered spinal cord stimulator

2018 ◽  
pp. bcr-2018-225813
Author(s):  
Sameer Jain ◽  
Michael A Fishman ◽  
Chengyuan Wu
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Back Pain ◽  
Pulse Generator ◽  
Chronic Back Pain ◽  
Low Back ◽  
Spinal Cord Stimulator ◽  
Technological Advances ◽  
Internal Pulse Generator ◽  
Neurosurgical Intervention

Spinal cord stimulation has been an effective therapy for treatment of chronic low back pain over the last four decades. Over the years, there have been significant technological advances in the neuromodulation devices. Externally powered neuromodulation devices, that do not require an internal pulse generator (IPG) implantation, have recently been approved for treatment of chronic pain and the data on potential pitfalls and unforeseen complications with these devices is minimal. Here, we report a case of a 60-year-old woman with chronic back pain who underwent the implantation of one of such devices and developed complication that required neurosurgical intervention. The epidural stimulator leads in the patient migrated cranially to the T2 level that required extensive neurosurgical exploration. We believe this is the first reported case of such significant cranial epidural lead migration with the use of neurostimulation devices and demands more research into the safety of externally powered neurostimulation devices.

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