Sacral nerve stimulator removal

[callmeanesthesia]

I have a patient with a non-functional sacral nerve stim. Surgeon left the area. She wants it out. Considering SCS for her. Are they placed the same as a perc SCS, and could I just remove the SNS at the same time? Do they have any sort of anchoring?

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[lobelsteve]

Lead is tined. No anchors. Gentle and slow pull from overlying incision. I like removal over live fluoroscopy to see lead moving and not stretching.

 

[BobBarker]

They like to do a 3 incision technique like we might do in a pump that we have a hard time making the tunneler behave. And they like to place sutures at the extra incision. So if you clip the sutures and free up the lead at the extra incision it comes out pretty easy.


Pro tip: you can place a 14g or 13g needle over the lead tail and guide over the lead to mash down the tines at the distal end and the lead will come out easy.

 

[Orin]

I have a patient with a non-functional sacral nerve stim. Surgeon left the area. She wants it out. Considering SCS for her. Are they placed the same as a perc SCS, and could I just remove the SNS at the same time? Do they have any sort of anchoring?

The older first generation ones had an anchor to the bone in addition to the tines. The more recent ones can be pulled out with tension but the lead is more flexible than an SCS lead and can shear. I recommend using the torq wrench to release the array from the sacral stim battery. Normally there's a small perc incision over the medial border of the sacral foramen where they accessed. Pull the lead back to that incision. Then use a 14g angiocath over the lead to try to blunt dissect down to the tines and maybe over them as they're not super strong. If you're using Abbott, their lead implant kit has that long blue angiocath that is perfect for it. You may want to use your backup stylet from the perc kit to make the lead stiffer and then pull it all out as one unit. I don't recommend using the needle as it can cut the lead, but you may be better with it than I am.

It's not hard but just a little different. Remember that you can bill for the different codes for removing a sacral lead and peripheral generator.