Chronic infection of a Brindley sacral nerve root stimulator

Abstract

SUMMARYThe Finetech-Brindley sacral anterior root stimulator (SARS) is implanted for the treatment of bladder dysfunction following spinal cord injury (SCI) and has been successful in improving micturition in many patients with SCI. This case describes a 62-year-old man who presented with a chronic Staphylococcus aureus infection of a Brindley SARS 26 years after implantation following a T5 American Spinal Injury Association A spinal cord injury (T5 ASIA A SCI). He presented with chronic sacral osteomyelitis with a history of periodic implant erosion through the skin. Following a series of interventions, definitive management involved removal of the intradural electrodes and epidural and intradural phlegmon, ligation of the thecal sac and flap reconstruction. In the case of delayed infection of a Brindley SARS, removal of the entire system should be considered, especially if extension of the infection to the intradural compartment is suspected. BACKGROUND

Treatment of the infected sacral nerve stimulator: A scoping review

“…However, it appears all reported cases pertaining to abscess formation secondary to infected SNS implant required explantation. 9,17 There is no consensus on the antibiotic choice, method of administration, dose, and duration of administration for patients undergoing antibiotic therapy for infected SNS. General advice has been published, and cephalosporins are the most used antibiotic for infected SNS, given Staphylococcus aureus is the most common cause.…”

“…There are no guidelines stipulating which patients should undergo a trial of conservative management versus immediate complete explant, and it seems current treatment is influenced by treating surgeon and local hospital guidelines. However, it appears all reported cases pertaining to abscess formation secondary to infected SNS implant required explantation 9,17 …”

“…The literature presents a population that will fail conservative management and require explantation of their infected SNS system 9,10,17,19,25,30 . There is currently no data identifying populations at higher risk of failing conservative management.…”

“…2 The literature presents a population that will fail conservative management and require explantation of their infected SNS system. 9,10,17,19,25,30 There is currently no data identifying populations at higher risk of failing conservative management. It is not clear which patients should undergo immediate explantation of their device, although staged implantations are more likely to have infection that require explantation.…”

Spinal Cord Stimulation Research in the Restoration of Motor, Sensory, and Autonomic Function for Individuals Living With Spinal Cord Injuries: A Scoping Review

“…A critical but poorly reported area of interest was risk and safety. A handful of studies specifically included the assessment of the risks and safety of ESCS 48,51,[63][64][65][66] or the potential use of ESCS as a home therapy. 67 Unfortunately, not one study was designed and conducted to specifically examine risk and safety of TSCS or magnetic SCS for those with SCI, nor was an article found that addressed adverse events associated with research or the use of these devices in the community setting.…”