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

Abstract

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

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

“…Unlike lead migration, IPG-related complications have rarely been reported. The majority of IPG-related revision surgeries pertain to IPG battery depletion, which, in the case of rechargeable IPGs, is easily remedied via recharging and seldom requires revision surgery (20)(21)(22)(30)(31)(32). It is important to make a distinction between complications and revision surgeries.…”

“…Some studies have reported IPG-related complications, which include battery flipping, recharging difficulties, and pressure necrosis from prolonged sitting (22,30). However, this scarcity of literature on IPG-related complications can by no means be an accurate representation of the actual number of patients who have IPG-related complications.…”

A Fully Implantable Miniaturized Liquid Crystal Polymer (LCP)-Based Spinal Cord Stimulator for Pain Control

“…Despite their successes in alleviating the chronic pain, these devices have several limitations, which originated from the following features. Since IPGs are packaged by the metal, its volume and the weight are fairly bulky and heavy (i.e., the volume and the weight of the PrimeAdvanced are around 40 cm 3 and 70 g, respectively), leading to various complications after implantation as well as restriction in the implantation location (i.e., hip or abdomen) [4,13,19]. Since the location of the implanted IPG is distant away from the actual stimulation position, a long lead wire is required to connect the electrode and the IPG [13,17], which results in complicated surgery for making a tunnel under the skin and risk of infection of a widespread lead wire.…”