• Markus A Bendel, Travis O'Brien, Bryan C Hoelzer, Timothy R Deer, Thomas P Pittelkow, Shrif Costandi, David R Walega, Gerges Azer, Salim M Hayek, Zhen Wang, Jason S Eldrige, Wenchun Qu, Joshua M Rosenow, Steven M Falowski, Stephanie A Neuman, Susan M Moeschler, Catherine Wassef, Christopher Kim, Tariq Niazi, Taher Saifullah, Brian Yee, Chong Kim, Christine L Oryhan, Daniel T Warren, Imanuel Lerman, Ruben Mora, Michael Hanes, Thomas Simopoulos, Sanjiv Sharma, Chris Gilligan, Warren Grace, Timothy Ade, Nagy A Mekhail, John P Hunter, Daniel Choi, and Deborah Y Choi.
• Mayo Clinic, Rochester, MN, USA.
• Neuromodulation. 2017 Aug 1; 20 (6): 553-557.

IntroductionSurgical site infection is a potential complication of spinal cord stimulator (SCS) implantation. Current understanding of the epidemiology, diagnosis, and treatment of these infections is based largely on small clinical studies, many of which are outdated. Evidence-based guidelines for management of SCS-related infections thus rely instead on expert opinion, case reports, and case series. In this study, we aim to provide a large scale retrospective study of infection management techniques specifically for SCS implantation.MethodsA multicenter retrospective study of SCS implants performed over a seven-year period at 11 unique academic and non-academic institutions in the United States. All infections and related complications in this cohort were analyzed.ResultsWithin our study of 2737 SCS implant procedures, we identified all procedures complicated by infection (2.45%). Localized incisional pain and wound erythema were the most common presenting signs. Laboratory studies were performed in the majority of patients, but an imaging study was performed in less than half of these patients. The most common causative organism was Staphylococcus aureus and the IPG pocket was the most common site of an SCS-related infection. Explantation was ultimately performed in 52 of the 67 patients (77.6%). Non-explantation salvage therapy was attempted in 24 patients and was successful in resolving the infection in 15 patients without removal of SCS hardware components.DiscussionThis study provides current data regarding SCS related infections, including incidence, diagnosis, and treatment.© 2017 International Neuromodulation Society.

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