Anesth Pain Med.  2021 Jan;16(1):103-107. 10.17085/apm.20054.

Unexpected extrusion of the implantable pulse generator of the spinal cord stimulator - A case report -

• Choi EJ
• Ri HS
• Park H
• Kim HJ
• Yoon JU
• Byeon GJ

• KMID: 2512288
• DOI: http://doi.org/10.17085/apm.20054

Abstract

Background
Despite significant technological advances in the implantable pulse generator (IPG), complications can still occur. We report a case that unexpected extrusion of the IPG of spinal cord stimulation (SCS) was promptly identified and successfully removed without any complications. Case: After a car accident 4 years ago, a 55-year-old man who was diagnosed with complex local pain syndrome in his right leg. The SCS was inserted with 2 leads, with the IPG being implanted in the right lower abdomen region. Four years later, he developed extrusion of the IPG from his abdominal region. This unexpected extrusion may have been related to pressure necrosis caused by continued compression of pocket site where a belt was frequently tied. The IPG and the leads were successfully removed without infection occurring.
Conclusions
To prevent unexpected extrusion of IPG, it is necessary to consider in advance whether the pocket site is pressed against the belt.

Keyword

Complex regional pain syndrome; Extrusion; Necrosis; Neuromodulation; Spinal cord stimulation

Figure

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  Fig. 1. The lead tips were located at the T10-T12 (paddle lead) and L1-L2 (cylindrical lead) level on simple X-ray L-spine anterior-posterior view.

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  Fig. 2. The implantable pulse generator was extruded at the lower abdominal pocket site.

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  Fig. 3. The lower abdominal pocket site was thoroughly cleaned and debrided after implantable pulse generator removal, and the wound was sutured.

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