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| 22KS-028 |
Extrusion of an implantable pulse generator of a spinal cord stimulator in a morbidly obese patient
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Introduction: Spinal cord stimulation (SCS) has been used for chronic refractory pain such as failed back surgery syndrome (FBSS). Hardware-related complications could occur after SCS insertion, like extrusion of an implantable pulse generator (IPG).
Case: A morbidly obese 81-year-old female patient with a body mass index of 37.7 (height, 147.7 cm; weight, 82.4 kg) was referred to our pain clinic in February 2020. In 2006, she had undergone posterior lumbar interbody fusion at L4-5. Since 2019, she had newly developed lower back pain with both radiating leg pain and neurogenic intermittent claudication. She was diagnosed with FBSS. The lead insertion for SCS test was performed in May 2020, and the intensity of pain measured using a numerical rating scale was decreased from 8 to 4. After a week, the IPG for permanent SCS was implanted in the left lower abdomen.
A year later, she suffered mild pain and redness in the abdominal IPG insertion site and visited the emergency room (ER) in July 2021. At the time, there was no tenderness, swelling, or fever. Because there was no clear sign of infection, a short-term follow-up at the pain clinic was decided. After that, pain and redness continued to worsen, and heating sense and tenderness appeared. The lesion was assessed as cellulitis related to IPG. It was planned to perform surgery to change the IPG site a few months later. However, after 2 weeks, the patient revisited ER due to extrusion of IPG from abdominal wall. The extrusion may have been due to pressure necrosis caused by continuous pressure on the skin and subcutaneous tissue related to obesity. Local infection of IPG insertion site was suspected. Surgery for changing the IPG site was performed the next day. Severe adhesion was found at the IPG insertion site. The lead connected to IPG could not be free to move because of severe adhesion at IPG insertion site. Therefore, the whole SCS was removed. The operation site was closed after irrigation with saline and diluted betadine. She was discharged with clear wound 2 weeks after the surgery.
Conclusion: When implanting a IPG in obese patients, the possibility of IPG extrusion from the implanted site should be considered.
Reference: Eldabe S, Buchser E, Duarte RV. Complications of Spinal Cord Stimulation and Peripheral Nerve Stimulation Techniques: A Review of the Literature. Pain Med. 2016;17(2):325-336.
Case: A morbidly obese 81-year-old female patient with a body mass index of 37.7 (height, 147.7 cm; weight, 82.4 kg) was referred to our pain clinic in February 2020. In 2006, she had undergone posterior lumbar interbody fusion at L4-5. Since 2019, she had newly developed lower back pain with both radiating leg pain and neurogenic intermittent claudication. She was diagnosed with FBSS. The lead insertion for SCS test was performed in May 2020, and the intensity of pain measured using a numerical rating scale was decreased from 8 to 4. After a week, the IPG for permanent SCS was implanted in the left lower abdomen.
A year later, she suffered mild pain and redness in the abdominal IPG insertion site and visited the emergency room (ER) in July 2021. At the time, there was no tenderness, swelling, or fever. Because there was no clear sign of infection, a short-term follow-up at the pain clinic was decided. After that, pain and redness continued to worsen, and heating sense and tenderness appeared. The lesion was assessed as cellulitis related to IPG. It was planned to perform surgery to change the IPG site a few months later. However, after 2 weeks, the patient revisited ER due to extrusion of IPG from abdominal wall. The extrusion may have been due to pressure necrosis caused by continuous pressure on the skin and subcutaneous tissue related to obesity. Local infection of IPG insertion site was suspected. Surgery for changing the IPG site was performed the next day. Severe adhesion was found at the IPG insertion site. The lead connected to IPG could not be free to move because of severe adhesion at IPG insertion site. Therefore, the whole SCS was removed. The operation site was closed after irrigation with saline and diluted betadine. She was discharged with clear wound 2 weeks after the surgery.
Conclusion: When implanting a IPG in obese patients, the possibility of IPG extrusion from the implanted site should be considered.
Reference: Eldabe S, Buchser E, Duarte RV. Complications of Spinal Cord Stimulation and Peripheral Nerve Stimulation Techniques: A Review of the Literature. Pain Med. 2016;17(2):325-336.
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