A Spinal Cord Stimulator (SCS) is a device implanted beneath the skin that uses mild electrical current to interrupt pain signals before they reach the brain, offering a form of relief for individuals with chronic pain. While SCS systems are designed to be long-term therapeutic tools, circumstances sometimes necessitate their removal, a procedure medically termed explantation. Deciding to remove the device involves careful consideration of the patient’s current pain status and the hardware’s condition. The explantation process is a surgical procedure focused on safely retrieving all implanted components, including the battery and the stimulating leads. This operation is approached with the same surgical precision used during the initial implantation, aiming for a smooth recovery.
Common Reasons Requiring Removal
The most frequent reason patients undergo SCS explantation is inadequate pain control or a loss of therapeutic effect over time. Even after a successful trial period, the device may no longer provide the expected reduction in chronic pain, which accounts for a significant percentage of removals. Another common trigger involves hardware issues, such as the stimulating leads moving from their original, targeted position near the spinal cord. Lead migration causes the electrical stimulation to be directed to an ineffective area, leading to a recurrence of the original pain. Infection is a serious complication that necessitates removal, often occurring around the Implantable Pulse Generator (IPG) or battery site, and typically presents with localized swelling, redness, or fever. Device component failure, or patient request due to unpleasant stimulation, hardware discomfort, or the need for MRI incompatible with their older SCS model, may also prompt explantation if revision is not a viable option.
The Surgical Removal Procedure
The SCS explantation procedure is performed in a hospital or surgical center, generally requiring general anesthesia, with the surgeon making an incision over the IPG site (usually located in the lower back, abdomen, or upper buttocks) to disconnect and remove the battery pack. A separate incision is typically made along the spine to access the leads positioned in the epidural space near the spinal cord. The complexity of lead removal depends heavily on the type of lead originally implanted; percutaneous leads are generally easier to remove than paddle leads. Paddle leads require careful dissection to free them from the surrounding scar tissue, or fibrotic capsule, that forms over time. Once all components are safely retrieved, both the IPG and lead incisions are closed with sutures.
Potential Complications Following Explantation
While SCS removal is a generally safe procedure, it carries specific risks related to the hardware’s proximity to the nervous system. The most specific complication is the possibility of a Cerebrospinal Fluid (CSF) leak, which can occur if the dura mater, the membrane surrounding the spinal cord, is accidentally punctured during lead removal. This complication is more likely with paddle leads due to the necessary dissection of the surrounding scar tissue, and a CSF leak can cause symptoms like a severe positional headache requiring further intervention. Infection at the surgical site remains a potential complication, though the risk is minimized with prophylactic antibiotics and sterile technique. Bleeding and the formation of a hematoma can occur at the incision sites, and in rare instances, manipulation of the leads near the spinal cord can lead to new neurological symptoms, such as weakness or sensory changes.
Recovery and Post-Removal Expectations
Following explantation, most patients spend one night in the hospital for observation, particularly after a more involved paddle lead removal. Initial recovery focuses on wound care for the two surgical sites, which must be kept clean and dry for the first few days to prevent infection, and localized pain can be managed with prescribed medication. Activity restrictions are put in place for several weeks to allow the surgical wounds to heal completely, involving avoiding strenuous activities, heavy lifting, and excessive twisting or bending of the spine. The full recovery timeline for returning to normal daily activities often ranges from two to four weeks, with a follow-up appointment scheduled to check healing and remove sutures. For patients whose SCS was removed due to inadequate pain relief, the primary long-term expectation is the return of their original chronic pain, requiring management with a pain specialist to explore alternative therapies.