A spinal cord stimulator (SCS) is a device used to manage chronic pain when other treatments are ineffective. The procedure involves implanting electrodes and a small generator pack, which creates scars near the spine and generator site. While the surgery is often successful, problems can develop at these incision sites. Complications can range from minor issues to more serious problems requiring medical attention.
Identifying Complications at the Scar Site
An immediate concern at an incision site is infection. Signs of a superficial infection include redness that spreads from the scar, warmth in the area, and noticeable swelling. An advanced infection may produce a yellow or green discharge (pus) with a foul odor. A fever can also accompany a localized infection, indicating the body is fighting a more significant problem.
Issues can also arise from the implanted hardware. The skin over the generator or leads may thin and take on a shiny appearance. In a process called skin erosion, parts of the device may become visible or feel like sharp edges beneath the surface. Another complication is device migration, where the electrodes move from their original placement. This can reduce the effectiveness of pain relief and might require a follow-up procedure to reposition them.
The healing process can also lead to abnormal scar formation. A hypertrophic scar is a raised, red formation that stays within the boundaries of the surgical incision. A keloid is a more aggressive scar that grows beyond the initial wound, creating a larger growth on the skin. A granuloma, a type of scar tissue, can also form on the leads or at the battery site.
Pain localized to the scar, distinct from the chronic pain the SCS treats, is another complication. This discomfort can be a persistent sharp, burning, or aching sensation at the incision. This pain may be related to superficial nerves affected during surgery that become entrapped in scar tissue.
Underlying Causes of Scar-Related Problems
Post-operative infections are a primary cause of complications. Bacteria from the patient’s skin, such as Staphylococcus, can enter the wound during or after surgery. If not addressed, a superficial infection can progress deeper into the tissue. This can affect muscle layers or lead to a systemic infection.
A patient’s overall health influences their ability to heal from surgery. Conditions like diabetes can impair circulation and the immune response. This slows down the healing process and makes infections more likely to occur.
The body may have an adverse reaction to the implanted device. Although uncommon, an allergic reaction to materials like silicone or titanium can occur. The body’s response to a foreign object can also lead to excessive scar tissue formation. If the generator is placed too close to the skin, the pressure can restrict blood flow and lead to skin erosion.
Medical Interventions and Treatment Options
Treatment for complications depends on the specific issue. For infections, the first line of defense is a course of oral or intravenous antibiotics based on the suspected bacteria. If caught early, this may be sufficient for a superficial infection. More severe infections that have penetrated deeper may require surgical intervention, such as a washout or debridement, to clean the wound. In the most severe cases, the entire SCS system may need to be removed to control the infection.
When the device is the problem, surgery is often the solution. If the generator or leads have migrated or are eroding through the skin, a revision surgery is necessary. A surgeon may create a new, deeper pocket to house the generator, providing a thicker tissue cushion. If the leads have moved, they will be repositioned to restore effective pain stimulation.
For abnormal scar formation, several non-surgical and surgical options are available to improve the appearance and feel of hypertrophic scars and keloids.
- Silicone sheets or gels can flatten and soften scar tissue.
- Corticosteroid injections can reduce the scar’s size and redness.
- Laser therapy can improve the texture and color of persistent scars.
- Scar revision surgery involves removing the old scar and re-closing the wound.
Prevention and Proper Post-Operative Care
Following the surgeon’s post-operative instructions is fundamental to preventing complications. This includes keeping the incision clean and dry for a specified period. Activity restrictions, such as avoiding stretching, twisting, or heavy lifting, prevent pulling on incisions and disrupting the device’s position.
Daily monitoring of the incision sites is a proactive step. Regularly inspecting the scars helps catch early warning signs of infection or device-related issues. Noticing increased redness, swelling, or drainage allows for prompt communication with a healthcare provider, which can lead to simpler treatment.
It is important to know when to seek medical advice. Signs of a possible infection, such as a fever, pus from the incision, or spreading redness, warrant immediate contact with a doctor. If the device becomes visible under the skin or feels like it is about to break through, medical attention is also needed right away. Other concerns, like the scar’s appearance, can be discussed during scheduled follow-up appointments.
Supporting the body’s healing capabilities can aid recovery. A balanced diet rich in vitamins and protein provides resources for tissue repair. Avoiding smoking is also beneficial, as it improves circulation and oxygen delivery to the wound, reducing the risk of complications.