SCS Removal

[PMROralBoards]

I have one of these coming up soon. The original implanter has since retired and now the patient landed with me. I’ve been looking around but cannot find any discussion of the procedure. Are the perc leads generally difficult to remove? I always use preop abx and vanc powder during irrigation for ipg exchanges/revisions/implants— is the vanc powder still normal to do if you are removing the whole system? I’ve looked around but cannot find any recommendations/guidelines. I appreciate any input.

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[BobBarker]

They just come out. Some of these older docs don’t even anchor the leads. You can pull the entire thing out from the IPG site at least 50% of the time. No indication for vanc powder. There is no foreign body to try to protect. But I don’t rec vanc powder for implants either.

 

[PMROralBoards]

They just come out. Some of these older docs don’t even anchor the leads. You can pull the entire thing out from the IPG site at least 50% of the time. No indication for vanc powder. There is no foreign body to try to protect. But I don’t rec vanc powder for implants either.

Thank you

 

[BobBarker]

If they are anchored, I remove the IPG first then cut the leads with scissors. Then free up the anchors, and pull out the remaining leads all at once.

 

[Agast]

The part that takes a surprisingly long time is finding the anchor and dissecting it out. It will be encapsulated and a tangled mess. I find it easiest to lift the free ends and use a scalpel to free the bottom portion from the fascia.

 

[Orin]

I have one of these coming up soon. The original implanter has since retired and now the patient landed with me. I’ve been looking around but cannot find any discussion of the procedure. Are the perc leads generally difficult to remove? I always use preop abx and vanc powder during irrigation for ipg exchanges/revisions/implants— is the vanc powder still normal to do if you are removing the whole system? I’ve looked around but cannot find any recommendations/guidelines. I appreciate any input.

Removal is generally very easy.

Pre-op abx are appropriate.
Open the IPG pocket. Cut the leads.
Tug on them gently to identify where they are anchored. Do that gently so as not to extract the leads until you've found the anchor.
Open that incision and use gentle tugs to identify the anchors.
Dissect out the anchors and suture material.
Pull the leads out.
Score the IPG pocket and consider throwing sutures to close the dead space.
Close a little looser so things can drain and consider external pressure for 48-72h to help reduce fluid pockets forming.

I have been avoiding irrigating with antibiotic containing solutions. The antiseptic containing solutions like Home - Irrisept have more reliable data for benefit and don't seem to come with the struggles of antibiotic resistance.

Incisional Wound Irrigation for the Prevention of Surgical Site Infection

This systematic review and network meta-analysis investigates the outcomes of using different types of prophylactic intraoperative incisional wound irrigation solutions for the prevention of surgical site infections.

jamanetwork.com

 

[MitchLevi]

Open up midline incision and pull leads out of the epidural space and externalize them

Free the anchors

Open IPG pocket and externalize the IPG

Cut the leads and pull them out

Close the wounds

No need to irrigate or use vancomycin powder

 

[BobBarker]

@Orin you are a really excellent surgeon from what you have posted here and in other threads. What is your background?