Spinal Cord Stimulator Removal
Anesthesia type

General

Airway

ETT

Lines and access

1 PIV, +/- A-line

Monitors

Standard, 5-lead EKG

Primary anesthetic considerations
Preoperative
Intraoperative

TIVA for neuromonitoring, prone positioning

Postoperative
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Neuromodulatory techniques such as spinal cord stimulation (SCS) are playing an increasing role in chronic pain management. The SCS leads are placed in the dorsal epidural space, either surgically or percutaneously, and are connected to a subcutaneously implanted programmable pulse generator.

They are most commonly removed for inadequate pain relief, but can also be removed for lead migration, device damage, infection, etc.

Overview

Indications

Surgical procedure

Paddle leads are larger and usually anchored to the spinal column under a small piece of bone.

Preoperative management

Patient evaluation

System Considerations
Airway Prone positioning
Neurologic Careful neurological exam to document preexisting deficits
Cardiovascular Chronic pain can lead to decreased physical activity & decreased cardiovascular reserve.
Pulmonary
Gastrointestinal Chronic opioid use may lead to decrease gastric emptying & decreased GI motility
Hematologic Multilevel laminectomy may be needed. Active type & screen.
Renal
Endocrine
Other

Labs and studies

CBC

Operating room setup

TIVA

Patient preparation and premedication

Chronic opioid use may lead to difficulty with pain control postoperatively. Consider multimodal treatment & acute pain consult.

Regional and neuraxial techniques

Intraoperative management

Monitoring and access

1 good IV

+/- A-line

Induction and airway management

General endotracheal anesthesia.

Positioning

Prone

Maintenance and surgical considerations

TIVA for neuromonitoring

Emergence

Postoperative management

Disposition

PACU

Pain management

Potential complications

Epidural hematoma

Spinal cord injury

Procedure variants

Variant 1 Variant 2
Unique considerations
Indications
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications

References