Perioperative management of spinal cord stimulators in patients undergoing non-SCS spine surgery: A retrospective cohort study

Abstract

Background Spinal cord stimulation (SCS) use has expanded, so perioperative teams increasingly encounter these devices during unrelated spine surgery, where leads, anchors, and the generator may lie within or adjacent to the operative field. Real-world perioperative management of these devices remains uncharacterized. Objective To characterize documented perioperative SCS management in adults undergoing non-SCS spine surgery and to benchmark prespecified management elements against current practical guidance. Methods In this single-center retrospective pilot cohort study, we identified adults (≥18 years) with a previously implanted SCS who underwent non-SCS spine surgery between April 1, 2016, and March 22, 2026. Prespecified primary outcomes were alignment with (1) preoperative deactivation or surgery mode and (2) appropriate electrocautery management (bipolar only, or monopolar with the generator contralateral to the return pad). Secondary outcomes were device-related adverse events. Analyses were descriptive, using frequencies and Wilson 95% confidence intervals (CIs). Results Fifty-eight surgical cases were included (mean age 59.2 [SD 13.8] years; 30 [51.7%] male; 42 [72.4%] instrumented fusion; all general anesthesia). Electrocautery was used in every case. Alignment with Element 1 was 13.8% (95% CI, 7.2 to 24.9) and to Element 2 was 43.1% (95% CI, 31.2 to 55.9); only 2 cases (3.4%; 95% CI, 1.0 to 11.7) met both. A perioperative plan was documented in 36.2% (95% CI, 25.1 to 49.1) and reactivation before discharge in 19.0% (95% CI, 10.9 to 30.9). Five cases (8.6%; 95% CI, 3.7 to 18.6) had an SCS-related adverse event, including one generator failure requiring replacement after monopolar cautery with an undocumented return-pad location. Conclusion Documented perioperative SCS management during non-SCS spine surgery was infrequent and fell short of current guidance in this pilot study, coexisting with a small but non-trivial rate of device-related adverse events. These gaps warrant prospective evaluation of structured protocols and defined pain-service engagement.