Perioperative Management of Spinal Cord Stimulators and Intrathecal Pain Pumps

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.

Automated summary

Orthopaedic surgeons should have a basic understanding of the function of spinal cord stimulators and intrathecal pain pumps, as they may encounter patients with these devices and need to manage potential complications and perioperative considerations. Referral for spine surgery may be necessary due to residual stenosis or deformity contributing to symptoms.