Perioperative Management of Spinal Cord Stimulators and Intrathecal Pain Pumps.
Alan H DanielsChristopher L McDonaldBryce A BasquesStuart H HershmanPublished in: The Journal of the American Academy of Orthopaedic Surgeons (2022)
Spinal cord stimulators (SCSs) and intrathecal pain pumps (IPPs) are implantable devices used in the management of chronic pain or spasticity. Complications, such as infection, lead migration/failure, cerebrospinal fluid leak, neurologic injury, and other medical complications, can occur after placement and may require surgical intervention. Orthopaedic surgeons may encounter patients with these devices and should have a basic understanding of their function. In addition, they should be aware that patients may have residual stenosis or deformity contributing to their symptoms; thus, spine surgery referral may be indicated. If a patient with a SCS or IPP is undergoing revision spinal surgery, a preoperative discussion regarding retention versus removal of the device is imperative because indications for device retention, revision, and removal are complex. This review summarizes potential complications and intraoperative considerations concerning the proper perioperative management of SCSs/IPPs and will provide evidence-based data regarding management strategies for these devices.
Keyphrases
- chronic pain
- spinal cord
- neuropathic pain
- patients undergoing
- spinal cord injury
- end stage renal disease
- healthcare
- total knee arthroplasty
- cerebrospinal fluid
- risk factors
- randomized controlled trial
- minimally invasive
- cardiac surgery
- chronic kidney disease
- primary care
- newly diagnosed
- ejection fraction
- prognostic factors
- case report
- risk assessment
- physical activity
- big data
- upper limb
- cerebral palsy