Introduction: Spinal cord stimulation (SCS) is an accepted efficacious method to control chronic pain(1) Low back pain is the second most common cause of disability in US adults (2). Postoperative infections resulting in explantation followed by new implantation is costly. Average infections rate are at 2-8 % (3). We devised a strategy to minimize postoperative infection and present our outcomes.
Methods: 84 consecutive SCS patients were operated by the same surgeon between 2012-2016. All patients were treated as outpatients. 65 patients were operated at Government-owned and operated county hospital, 19 at a private, for-profit community hospital.
1. Patients back to prepped in 3 steps: 1. Soap and warm water 2. Betadine 3. Cholraprep
2. Preoperative Ancef (Vancomyecin if allergic to Penicillin)
3. All implanted hardware was exposed to Vancomyecin powder
4. Wound edges were exposed to Vancomyecin powder at closure
5. Superficial wound closure with Dermabond
6. Only personnel scrubbed during case is operating surgeon and scrub tech - no assistant surgeon
7. Patient placed on oral Keflex and Bactrim post-op x 10 days (If allergic to Penicillin Clindamycin)
All patients were assessed at 6 weeks post-op for any signs or symptoms of infection.
Results: No infections at either the paddle implant sites or the pulse generator implant sites were observed in 84 consecutive patients. Furthermore, if prior percutaniously placed hardware had to be removed, no infections were observed at these explantation sites either.
Conclusions: The initial outcomes of this protocol look favorable in the prevention of postoperative infections in SCS patients compared to published data. Larger numbers of patients are necessary to add power to these conclusions.
Patient Care: Applying the described protocol may decrease postoperative wound infections in patients with paddle spinal cord stimulator implants.
Learning Objectives: By the conclusion of this session, participants should be able to:
1. Be familiar with SCS as a solution for chronic pain.
1. Describe the risks associated with SCS paddle implants.
2. Identify a reasonable protocol to decrease postoperative infections.
References: 1. Lamer TJ, Deer TR, Hayek SM. Advanced Innovations for Pain. Mayo Clin Proc. 2016 Feb; 91(2): 246-58
2. Centers for Disease Control and Prevention. JAMA 2001; 285(12):1571-72
3.Engle MP, Vinh BP, Harun N, Koyyalagunta D. Infectious complications relayed to intrathecal delivery systems and spinal cord stimulator system implantations at a comprehensive cancer pain center. Pain Physician. 2013 May-Jun; 16(3): 251-7