Is spinal cord stimulation safe? A review of its complications

Abstract

Objective: We aim to evaluate the complications of spinal cord stimulation (SCS).

Methods: This article is a nonsystematic review of literature about the safety of SCS. The complications of this technique are described, focusing the analysis in their prevention, diagnosis, and treatment.

Results: Electrode migration is the most common complication of SCS and it is more frequent with percutaneous electrodes than with paddle-type ones. Lead migration may be solved by reprogramming the stimulator, but if it fails, surgical repositioning is mandatory. Several anchoring techniques are described in the text. Infection is a potentially reducible complication associated with the surgical procedure and the reported infection rates are comparable with those of several neuromodulation devices. Recommendations for the prevention of SCS device infections are listed in the article. Other complications were reviewed such as electrode fracture, extension wire or implantable pulse generator failures, cerebrospinal fluid leakage, pain over the stimulator, and spinal epidural hematoma, among others.

Conclusion: In spite of the existence of several complications, SCS may be seen as a safe technique. Furthermore, the incidence of life-threatening complications is low. The physician must be alert to recognize them during the follow-up. Complications may be avoided or at least diminished by performing a proper and strict aseptic surgical technique as well as carrying out an accurate patient selection before the implantation, according to the recommendations published in the literature.

Keywords: Complications; Electrode migration; Infection; Neuromodulation; Spinal cord stimulation.