• Sean J Nagel, Leonardo Frizon, Tanmoy Maiti, Andre G Machado, George T Gillies, Logan Helland, Royce W Woodroffe, Matthew A Howard, and Saul Wilson.
• Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA.
• World Neurosurg. 2019 Aug 1; 128: e397-e408.

IntroductionContemporary approaches to surgical site infections have evolved significantly over the last several decades in response to the economic pressures of soaring health care costs and increasing patient expectations of safety. Neurosurgeons face multiple unique challenges when striving to avoid as well as manage surgical implant infections. The tissue compartment, organ system, or joint is characterized by biological factors and physical forces that may not be universally relevant. Such implants, once rare, are now routine. Although the prevention, diagnosis, and treatment of surgical site infections involving neural implants has advanced, guidelines are ever changing, and the incidence still exceeds acceptable levels. We assess the impact of these factors on a new class of implantable neuromodulation devices.MethodsThe available evidence along with practice patterns were examined and organized to establish relevant groupings for continuing evaluation and to propose justifiable recommendations for the treatment of infections that might arise in the case of intradural spinal cord stimulators.ResultsFew studies in the modern era have systematically evaluated preventive behaviors that were applied to intradural neural implants alone. We anticipate that future efforts will focus even more on the investigation of modifiable factors along a continuum from bacterially repellant implants to weight management. Early diagnosis could offer the best hope for device salvage but to date has been largely understudied.ConclusionsHistorically, prevention is the cornerstone to infection mitigation. However, immediate diagnosis and hardware salvage have not received the attention deserved, and that approach may be especially important for intradural devices.Copyright © 2019 Elsevier Inc. All rights reserved.

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