Pain practice : the official journal of World Institute of Pain · 2026
Capsulectomy at Explant: Rethinking Spinal Cord Stimulator Infected Generator Pocket Management in the Immunocompromised-A Case Series.
Клинический случайСтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Kesayan Tigran, Motamedi Vida, Hanflink Jessica, Assi Patrick, Kassis Salam
Аннотация
BACKGROUND: Surgical site infections (SSI) associated with spinal cord stimulation (SCS) implants pose risks of morbidity, mortality, and increased healthcare costs. Immunocompromised patients are especially vulnerable due to impaired immune responses, delaying diagnosis and increasing complications. Current guidelines recommend SCS explantation for deep or inadequately treated superficial SSI, though the role of capsulectomy remains underexplored despite its use in other fields like plastic surgery and cardiology.
CASE PRESENTATION: We present two cases of immunocompromised patients with SSI treated with SCS explantation and capsulectomy. Case 1 involved a 64-year-old woman with ulcerative colitis and psoriatic arthritis treated with immunosuppressive agents who developed fever and myalgia and had normal imaging. Despite treatment with a course of antibiotics, she developed granulation tissue at the midline incision which tracked to the lead anchors. Explantation revealed necrotic tissue, and capsulectomy of the implanted pulse generator pocket and around lead anchors was performed. Staphylococcus schleiferi, likely linked to pet exposure, was identified. Case 2 involved a 52-year-old woman with postlaminectomy syndrome and rheumatoid arthritis on immunosuppressants, who presented with erythema and wound dehiscence weeks post-implant. Explantation and capsulectomy were performed to remove fibrotic tissue potentially harboring biofilm. MRSA infection was identified. Targeted antibiotics facilitated recovery in both cases.
CONCLUSION: These cases suggest capsulectomy during SCS explantation may mitigate complications, particularly in immunocompromised patients. Current guidelines recommend capsule debridement but do not routinely address capsulectomy; its use may improve infection resolution in high-risk populations, perhaps by eliminating biofilm associated with the capsule.
CASE PRESENTATION: We present two cases of immunocompromised patients with SSI treated with SCS explantation and capsulectomy. Case 1 involved a 64-year-old woman with ulcerative colitis and psoriatic arthritis treated with immunosuppressive agents who developed fever and myalgia and had normal imaging. Despite treatment with a course of antibiotics, she developed granulation tissue at the midline incision which tracked to the lead anchors. Explantation revealed necrotic tissue, and capsulectomy of the implanted pulse generator pocket and around lead anchors was performed. Staphylococcus schleiferi, likely linked to pet exposure, was identified. Case 2 involved a 52-year-old woman with postlaminectomy syndrome and rheumatoid arthritis on immunosuppressants, who presented with erythema and wound dehiscence weeks post-implant. Explantation and capsulectomy were performed to remove fibrotic tissue potentially harboring biofilm. MRSA infection was identified. Targeted antibiotics facilitated recovery in both cases.
CONCLUSION: These cases suggest capsulectomy during SCS explantation may mitigate complications, particularly in immunocompromised patients. Current guidelines recommend capsule debridement but do not routinely address capsulectomy; its use may improve infection resolution in high-risk populations, perhaps by eliminating biofilm associated with the capsule.