ESI in patient with SCS

[oneforfighting]

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Patient has old lumbar SCS implant no longer functioning. Thoughts on doing a LESI? Risk of infection?

 

[buddababa]

Patient has old lumbar SCS implant no longer functioning. Thoughts on doing a LESI? Risk of infection?

same risk as a lesi in a patient with no scs, i do it all the time

 

[Ducttape]

as long as you are not intending to do the LESI at the exact level site where the lead enters the epidural space...

 

[paindoc007]

Not even a thought. I do all standard procedures on patients with scs (lesi, RFA, siji, etc)

 

[oneforfighting]

Thank you all

 

[Agast]

as long as you are not intending to do the LESI at the exact level site where the lead enters the epidural space...

Concern that fluid pressure will move the lead?

 

[Orin]

Patient has old lumbar SCS implant no longer functioning. Thoughts on doing a LESI? Risk of infection?

I generally don't bother unless there's an acute HNP as I assume they had ESIs prior to having failed into an SCS, but the main risk I worry about is the risk of hardware trauma/damage.

 

[oneforfighting]

I generally don't bother unless there's an acute HNP as I assume they had ESIs prior to having failed into an SCS, but the main risk I worry about is the risk of hardware trauma/damage.

This particular pt hasn't used his system for 12-13 years. I figure there’s a chance that he’s got some new degenerative changes worth a shot. I was taught in fellowship to avoid injecting those with implants for fear of infection. Think that was overblown.

 

[Ducttape]

Concern that fluid pressure will move the lead?

id be concerned about infection, less with structural issues with contacting the stim, but still a slight concern

 

[IYKYK]

We give preop abx in my fellowship if patients have SCS or hardware. Does anyone else do that?

 

[agolden1]

We give preop abx in my fellowship if patients have SCS or hardware. Does anyone else do that?

Nope

 

[buddababa]

We give preop abx in my fellowship if patients have SCS or hardware. Does anyone else do that?

no, thats overkill, as longa s you're not touching the hardware and following proper sterile technique, you'll be fine.

 

[MitchLevi]

We give preop abx in my fellowship if patients have SCS or hardware. Does anyone else do that?

Antibiotic stewardship for $2000 Alex.

 

[Baron Samedi]

Concern that fluid pressure will move the lead?

3cc from an ESI won't affect it one bit. You can do a blood patch with 20cc immediately post op and it won't make a difference in lead placement.