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

Infection

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

• Incidence: approximately 5%
• Time to appearance of symptoms: typically weeks to months, but can be overnight post-procedure or, at the other extreme, several years if the infection arises from hematogenous seeding or slow-growing bacteria
• Treatment: Culture a specimen to guide antibiotic therapy, remove any involved portion of the SCS system (infections limited to the skin over the implant may be treated without removing the underlying, non-involved implant), and administer an appropriate course of antibiotics.  Note that the system will not function with any part removed, and eradicating the infection is easier if the foreign body implant is removed in its entirety.
• Usual resolution and impact on therapy: Infection usually resolves with appropriate treatment.  During the time the SCS system is removed, the patient must be treated for pain by other means.  The SCS system can be reimplanted when the infection clears.
• Worst case adverse sequelae: paralysis, death.
• Risk reduction: Use normal sterile techniques, maintain sterile dressing during the screening trial phase, administer prophylactic intravenous antibiotics before permanent implantation.

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