A spinal cord stimulator (SCS) is an implanted device that delivers mild electrical pulses to the spinal cord to manage chronic pain. It works by interfering with pain signals before they reach the brain, often replacing discomfort with a tingling sensation (paresthesia) or, in newer systems, a sensation-free therapy. While SCS can improve quality of life by reducing pain and potentially decreasing reliance on medication, its removal sometimes becomes necessary or desired. This procedure, generally less complex than the initial implantation, involves specific patient considerations.
Reasons for Spinal Cord Stimulator Removal
A common reason for SCS removal is inadequate pain relief, even after a successful trial period. Some patients may not experience sustained pain reduction over time. This can occur if the device no longer effectively masks pain signals, or if the original pain condition progresses or changes.
Device malfunction or technical issues also commonly lead to removal. Lead migration, where the wires shift from their intended position, can cause stimulation to become less effective or target unintended areas. Other hardware problems, such as lead fracture or battery failure, can render the device inoperable.
Infection at the implant site is a serious complication that often necessitates SCS removal. This can occur around the battery pack or along the leads, presenting as redness, swelling, pain, or discharge. Discomfort from the implanted hardware, such as pain at the implant site, can also prompt removal even if pain relief is adequate. Incompatible medical imaging, such as MRI, can also necessitate explantation.
The Spinal Cord Stimulator Removal Procedure
Before the removal procedure, patients undergo a medical evaluation to ensure they are suitable for surgery. This includes reviewing health history and current medications, and instructions to fast before the procedure. The procedure is performed under general anesthesia, ensuring the patient is asleep and pain-free throughout.
The surgical approach varies depending on the type of leads initially implanted. For percutaneous leads, inserted with a needle, a small incision is made along the back to extract them from the epidural space. If paddle leads were used, which are larger and anchored to the spinal column, a larger incision exposes scar tissue around the leads for detachment and removal. This may involve creating a small opening in the bone above the spinal cord.
After lead removal, a second incision is typically made in the lower back or buttock to extract the implantable pulse generator (battery pack). The entire procedure generally takes 2 to 2.5 hours, depending on complexity and lead type. It is often an outpatient procedure or may involve a short hospital stay for monitoring.
Recovery After Spinal Cord Stimulator Removal
Following removal, patients can expect some pain and discomfort at incision sites, managed with prescribed medication. Wound care instructions emphasize keeping the incision clean and dry, avoiding creams or ointments unless directed by a provider. Staples, if used, should remain in place until a follow-up visit, typically around two weeks post-surgery.
Complete healing typically ranges from two to four weeks. Activity restrictions are in place during this period to allow proper healing and prevent complications. Patients are advised to limit strenuous physical activity, including twisting, bending, or lifting anything heavier than 5 to 10 pounds for two to three weeks. Gentle walking can be resumed a few days after surgery, but more rigorous activities are gradually reintroduced as healing progresses.
Patients should anticipate the return of their original chronic pain, as the stimulator no longer interferes with pain signals. New pain, such as phantom pain or neuropathic pain from scar tissue, might emerge in some cases. Follow-up appointments are important to monitor healing, address any concerns, and discuss alternative pain management strategies.
Potential Complications of Spinal Cord Stimulator Removal
While spinal cord stimulator removal is generally safe, potential complications can arise. Infection at the incision site is a possible complication, manifesting as increased redness, swelling, warmth, or drainage. Patients are given instructions on proper wound care to minimize this risk.
Bleeding or hematoma formation beneath the skin is another potential issue. While often minor, significant bleeding may require further medical attention. Nerve damage is a theoretical risk due to the proximity of the leads to spinal nerves. This could lead to new or worsened neurological symptoms.
Cerebrospinal fluid (CSF) leak can occur, particularly when removing paddle leads anchored near the dura mater (the membrane surrounding the spinal cord). A CSF leak can cause headaches that worsen when upright and improve when lying down. Persistent pain or new pain, such as neuropathic pain from scar tissue, is also a possibility after removal. As with any surgical procedure involving anesthesia, there is a small risk of allergic reactions to anesthetic agents.