Complications of Spinal Cord Stimulation

Abstract

Spinal cord stimulation (SCS) is a therapy that offers hope to thousands of patients who suffer from chronic pain. The therapy has undergone significant advancements in recent years, including improved leads, more complex programmable generators, different arrays for achieving nerve activation, innovations in software, and novel waveform applications. But the implementation of SCS requires violation of our natural barrier, the skin, which innately can create adverse effects. Further, placement requires reliable identification of the epidural space and basic surgical skills, including sterile technique, anchoring, and incision closure. The assessment of the complications associated with SCS is difficult. Complications commonly are considered to be either biological or device-related. Systematic analyses have shown device complications to be 14-43 %. Nearly 80 % of these may require a surgical revision, and 11 % of patients in chronic therapy have a complication that requires removal of the device. The risk of life-threatening complications appears to be less than 1 %. The purpose of this chapter is to give an overview of important complications and to evaluate strategies to reduce the risk to the patient.