Spinal Cord Stimulator Related Infections: Findings From a Multicenter Retrospective Analysis of 2737 Implants Markus A. Bendel, MD*; Travis O’Brien, MD*; Bryan C. Hoelzer, MD*; Timothy R. Deer, MD † ; Thomas P. Pittelkow, DO*; Shrif Costandi, MD ‡ ; David R. Walega, MD § ; Gerges Azer, MD ‡ ; Salim M. Hayek, MD, PhD ¶ ; Zhen Wang, PhD*; Jason S. Eldrige, MD*; Wenchun Qu, MD, PhD*; Joshua M. Rosenow, MD § ; Steven M. Falowski, MD**; Stephanie A. Neuman, MD †† ; Susan M. Moeschler, MD*; Catherine Wassef, BS**; Christopher Kim, MD † ; Tariq Niazi, MD ‡ ; Taher Saifullah, MD ‡ ; Brian Yee, DO † ; Chong Kim, MD † ; Christine L. Oryhan, MD ‡‡ ; Daniel T. Warren, MD ‡‡ ; Imanuel Lerman, MD, MS §§ ; Ruben Mora, MD §§ ; Michael Hanes, MD ¶ ; Thomas Simopoulos, MD ¶¶ ; Sanjiv Sharma, MBBS, FRCA ¶¶ ; Chris Gilligan, MD ¶¶ ; Warren Grace, MD † ; Timothy Ade, MD ¶ ; Nagy A. Mekhail, MD ‡ ; John P. Hunter, MD † ; Daniel Choi, MD***; Deborah Y. Choi, PhD*** Introduction: Surgical site infection is a potential complication of spinal cord stimulator (SCS) implantation. Current understand- ing of the epidemiology, diagnosis, and treatment of these infections is based largely on small clinical studies, many of which are outdated. Evidence-based guidelines for management of SCS-related infections thus rely instead on expert opinion, case reports, and case series. In this study, we aim to provide a large scale retrospective study of infection management techniques specifically for SCS implantation. Methods: A multicenter retrospective study of SCS implants performed over a seven-year period at 11 unique academic and non-academic institutions in the United States. All infections and related complications in this cohort were analyzed. Results: Within our study of 2737 SCS implant procedures, we identified all procedures complicated by infection (2.45%). Local- ized incisional pain and wound erythema were the most common presenting signs. Laboratory studies were performed in the majority of patients, but an imaging study was performed in less than half of these patients. The most common causative organ- ism was Staphylococcus aureus and the IPG pocket was the most common site of an SCS-related infection. Explantation was ultimately performed in 52 of the 67 patients (77.6%). Non-explantation salvage therapy was attempted in 24 patients and was successful in resolving the infection in 15 patients without removal of SCS hardware components. Discussion: This study provides current data regarding SCS related infections, including incidence, diagnosis, and treatment. Keywords: Complication, infection, spinal cord stimulation, treatment Address for correspondence: Markus Bendel, MD, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA. Email: Bendel.markus@mayo.edu * Mayo Clinic, Rochester, MN, USA; † Center for Pain Relief, Charleston, WV, USA; ‡ Cleveland Clinic, Cleveland, OH, USA; § Northwestern University Medical Center, Chicago, IL, USA; ¶ Case Western, Cleveland, OH, USA; ** St. Luke University Health Network, Fountain Hill, PA, USA; †† Gundersen Health, LaCrosse, WI, USA; ‡‡ Virginia Mason Medical Center, Seattle, WA, USA; §§ University of California at San Diego, La Jolla, CA, USA; ¶¶ Beth Israel Deaconess Medical Center, Brookline, MA, USA; and *** Valley Pain Consultants, Scottsdale, AZ, USA For more information on author guidelines, an explanation of our peer review process, and conflict of interest informed consent policies, please go to http://www.wiley. com/WileyCDA/Section/id-301854.html www.neuromodulationjournal.com V C 2017 International Neuromodulation Society Neuromodulation 2017; ••: ••–•• Neuromodulation: Technology at the Neural Interface Received: April 12, 2017 Revised: May 22, 2017 Accepted: June 4, 2017 (onlinelibrary.wiley.com) DOI: 10.1111/ner.12636 1