Practice Parameters for the Use of Spinal Cord Stimulation in the Treatment of Chronic Neuropathic Pain

Generator Pocket Hematoma

What is the incidence, time to appearance of symptoms, usual resolution and impact on therapy, and worst case adverse sequelae of generator pocket hematoma following SCS treatment, and how can this risk be reduced?

  • Incidence: rare
  • Time to appearance of symptoms: variable (minutes to days)
  • Treatment: ranges from none needed to surgical evacuation
  • Usual resolution and impact on therapy: most resolve on their own; impact on therapy will obviously occur if generator must be removed.
  • Worst case adverse sequelae: discomfort; return to operating room
  • Risk reduction: Review the patient’s coagulation history, medications, and preoperative blood studies.  
Strength of recommendation Evidence source(s)/rationale
B = Recommended
Uncertain validity, apparently useful
  • Consensus
  • Cohort studies
  • Retrospective case series
  • Case reports 

Slavin KV, Burchiel KJ, Anderson VC, Cooke B. Efficacy of transverse tripolar stimulation for relief of chronic low back pain: results of a single center. Stereotact Funct Neurosurg 73(1-4):126-130, 1999.
Abstract | Wikistim Entry

Kumar K, Toth C, Nath RK, Laing P. Epidural spinal cord stimulation for treatment of chronic pain--some predictors of success. A 15-year experience. Surg Neurol 50(2):110-120, 1998.
Abstract | Wikistim Entry

Kumar K, Hunter G, Demeria D. Spinal cord stimulation in treatment of chronic benign pain: challenges in treatment planning and present status, a 22-year experience. Neurosurgery 58(3):481-494, 2006.
Abstract | Wikistim Entry

Kumar K, Wilson JR, Taylor RS, Gupta S. Complications of spinal cord stimulation, suggestions to improve outcome, and financial impact. J Neurosurg Spine 5(3):191-203, 2006.
Abstract | Wikistim Entry