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spinal cord stimulator revision

melanietnmmelanietn Posts: 8
edited 06/11/2012 - 8:43 AM in Spinal Cord Stimulation
Hi Everyone. I am 4 weeks post op from the Boston scientific spinal cord stimulator implant. I have had alot of pain at the battery/IPG site. 2 days post op the stimulation on my left side has been in my abdomen and ribcage, when it is suppose to be in my leg. The doctor told me Tuesday that they were going to have to go back in and move the lead because it must have moved a little. I have one 7 inch incision and they pushed the IPG over to the right side of my incision in my midline back. He said that they had to open the whole incision back up to move the lead. That just dosen't make sense to me. Has anyone had to have this done so soon after the implant? Is it easier to deal with the second time? I'm not sure that the pain I am still having from the battery/IPG is normal. He tells me that it's muscle pain and nerve from the scar tissue, but I think I know the pain is coming from the battery. Please any advice/experiences would be much appreciated. Thanks!
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Comments

  • I have not heard of anyone having a single 7 inch incision for a neurostimulator implant. Normally there are two 3 inch (aprox size) incisions, one for the leads and one for the IPG.

    Do you have a short torso possibly? I'm just wondering if instead of tunneling the short distance, your doc just opened the main incision to place everything. Can you ask him about it when you go for the revision?

    I've had 2 revisions. Both were at about 1 year post permanent implant and they were about 2 weeks apart. The first was to install new anchors and recreate my strain relief loops. The second was to secure one of my lead wires coming out of the IPG where the set screw had come loose allowing the wire to pull out. I found it easier to handle the revision on the IPG that the anchors, but the anchors had to have additional tissue pulled in to create a covering.

    Sorry that you are getting ribcage stimulation. I know how uncomfortable that can be. One thing to keep in mind, is that many times through reprogramming, that ribcage stimulation can be resolved. Changing the pulse width can drastically effect the depth of the stimulation and create a more pleasant sensation.

    Keep us posted on what your doc has to say.

    "C"
  • I started to comment on your other post when I decided to check and see if you created a new one. Welcome to the SCS side of the house. I do have some other questions:

    What is the SCS trying to stimulate, i.e. Legs, Back, Arms, Neck?

    Do you know what level the Leads were placed?

    My IPG is on my left side, just above the belt line near my hip. Others can chime in as to where there placement is, but my father-in-law had his in his butt on the left side. It sounds like the IPG is rather high in comparison to others, how hard is it to charge?

    Enough of the 20 questions for now and again welcome to our little group.

    Dave
  • Healing time is different for everyone...but I still had burning and pain in the incision about 6 weeks after implant. How did they determing the lead had moved? Was it through a x-ray? If not then I would request a x-ray to compare with the placement at the time of the surgery...if there is no change...than I would think (I DON'T KNOW) reprogramming would be able to fix the area of stimulation. I know they moved my stimulation. I was feeling the stimulation in the bottom of my foot and should be feeling in be in my pelvi. With a good programmer they were able to get it back where it felt wonderful. Maybe your rep can direct you in the right direction.
  • Don't know about revisions, but when I had mine placed initially, the doc gave me an rx for lidoderm patches to use after the incisions were healed for superficial pain where my battery was placed. I used them more for the lead incision which surprised my doc, he said most people complain more about the battery site incision.

    I also had problems initially with the heat from the charger bothering my battery, but that was only when my incision was fresh. With some help from C and the Boston Scientific rep, I found out that the charger needs to be on when you are NOT all covered up. The charger can heat up to 106 degrees F and then it automatically turns off(no notice to you.) C gave me suggestion of wearing nylon not cotton garments over the charger which really helped with temperature and pain.

    I'm almost 7 months out and I'm pretty well adjusted to the routine. I HATE abdominal or ribcage stimulation so I change my settings to fix it. I do get battery area discomfort if I bump it hard or lay on the floor directly on it. Overall, though, it's not a problem now. But I really liked those lidoderm patches at first, and ice packs when I still had staples.

    Good luck to you, I hope it works out and you get to enjoy the benefits of it.
  • Thanks everyone for your replies. He has not done an xray. He used fluoroscopy.He said that it had to of moved since they could not get any stimulation in my left leg. He said just a fraction of an inch could cause that. what concerns me most is why would they have to move the battery to the other side? it seems like they would not have to mess with that at all. I know that everything I have read talks about 2 incisions and was baffled when I wake up with this one looonnnggg incision. I have had 3 back surgeries and the incision is only 3 inches long. I have met with the rep at his office 3 times since the surgery and each time she turns on the left lead and tries anything it is in my ribcage and abdomen. she has that lead turned off now. from what I understand the right lead is in the midline and the left lead is over to the left.I heard him say that my last visit. I am not sure what level. The original areas to be stimulated were my legs. Mostly the left from nerve damage. That is where most of my pain is. My right thigh has nerve pain as well but that side is working fine. It is very easy to charge. The first couple of weeks it wasn't but I guess it was due to the swelling and all. now I just put it on there and it automatically stops beeping. It is so great to have people to talk to that have been through the same thing. I really appreciate this site! Also, I am trying to decide if I should go ahead with the revision or wait a few more weeks til I am completely healed from the first one. I feel like it may not be as bad if I let him do it now and get it over with. atleast I won't have to dread it for as long.
  • I found with surgery revisions, that it is far less painful to have them done sooner versus later. That's just what my experience has been.

    There are several different scenarios for moving an IPG from its original positioning. However just because a lead fell down into "the well", isn't one that I've heard about or read about being cause to move the IPG. If I were in your shoes, I would definitely take a list of questions to the doc and find out what the reasoning is behind his decision.

    Generally IPG's are moved due to charging problems, conflicts with other implants, to avoid excessive tunneling for lead wires, to avoid the need for extensions and due to possibility of damage from occupational hazards. Of course there are always exceptions to every norm, but these are pretty much the most common reasons.

    I have a very long torso and have discussed moving my IPG to avoid tearing out my anchors from bending too much. However, we decided to leave well enough alone for the time being, since I have no other issues and can charge just fine. Kind of the theory of "if it ain't broke, don't fix it". So I just have to be a bit more cautious of how much I bend while doing things and I have to avoid Yoga.

    Melanie do you know if your rep has tried to cross-talk your leads to see if when they work together, she can get good stimulation coverage without getting the ribcage stimulation?

    Well keep us posted on what you find out. I hope it is good news and they can get your SCS up and running like it's supposed to.

    "C"
  • I agree ask questions before you agree to anything. I was 12 weeks out when I had my revision. I wouldn't accept a "had to have moved" as an answer. My insurance wanted proof before they could schedule a revision. With the fluoroscopy they have pictures of exact placement and they can detect any movement. Again I was 12 weeks out and the 8 weeks of no BLT's started over...the rep had done many things with programming including cross talking...which seemed to really pull the stimulation into a fine tuned area. The stimulation was moved from my feet to my pelvic area with the use of cross talking. My rep will often call her supervisor to ask questions if she can't get it to work for me. I feel like I have a whole team of my own...and they are all great.
  • I am going to ask alot of questions tommorrow! they want to schedule the surgery as soon as possible so that I can get some much needed relief. I am dreading the whole "starting over" recovery period but I think it will be worth it once I'm over it. I know that it works because the trial and first couple of days after the initial surgery worked great. I hope all of you have a great week!
  • Hi everyone! I am now 3 days post op from my revision surgery.It was suppose to be an outpatient procedure but I ended up staying 2 days in the hospital because of my blood pressure being too low and an awful headache. Anyway, He went in the same incision but did move the battery/ipg because it was tilted. It is working now for the terrible nerve pain in my leg, thank God. However, this one seems even more so tilted than the previous, it is really sticking out there. I don't know if you are allowed to post pictures on this site or not but I wish I could show the picture of how he did this.
  • Melanie: Glad to hear your getting relief in your left leg. Sorry you had to spend 2 nights in the hospital that stinks!! Hope things keep going well.

    So I'm just trying to figure this out, I should have my trial placed mid July. There will be two incisions approx 2 inches one for the lead and one for the battery pack.

    ernurse: You mentioned wearing nylon clothing. Is that just when you are charging or do you where it all the time? Just trying to figure out what all I am going to need.

    I have read that you will need button up shirts after the trial so you will not raise your hands above your head? Mine will be placed for lumbar/leg issues, is this still the case? I bought some button up shirts for my trial and have some stretchy pants ready to go.

    Thanks for answering my questions.
  • HI. Sorry I haven't posted in a while. Rwill I have one incision, which according to everyone on here is unusual. My doctor said he does all of his with one incision. I am 4 weeks out from my surgery and feel so much better. The stimulation actually working in my leg has helped tremendously. Now, the only thing I am concerned about is the battery is sticking way out. My first one was tilted is the reason they moved it when they moved the lead. Has anyone had their battery stick out and it not cause any additional problems. I'm worried now. Do NOT want to go through anything else with this. Thanks.
  • I'd certainly press the issue now rather then later.
    If, it moved from where/how he wanted placed this time and it is close to your surgery date, he may be able to fix it where it is since it is not fully "scarred" in.

    Or he may have other suggestions as to how to get it to lay flatter, or something.

    As for the tilt, it may impede charging, get rubbed, bumped a lot and stay tender for a lot longer time if there is an edge or corner sticking out.

    This is just me here, thinking that if it was tilted and is again tilted, doing the procedure with one incision may not be such a grand idea? :?

    I hope you get things sorted out and it does not require any further surgery to correct.
  • Sorry to hear your having trouble with your battery. I would definately talk to your doc know like Wrambler said before it scars over. That is probably my greatest worry that the battery will poke out funny. I hope things work out!! Let us know what he says.
  • Looks like i may be in for a revision myself. Its been a year since my implant and multipule reprogrammings. At my PM appt today, they did 2 floroscope xrays to see what was going on. Well, my left leads have migrated from T9 to somewhere around L2. Im to go in next Tuesday for a possible reprogramming again. PM stated that if they cant get it close then i'll need to have a revision. Not good in my mind. Do i really want to go through another 8 weeks of rehab/healing. But i guess there is too much $$ and time invested in this not to try it if its my option.
  • So funny how we are all wired differently. My leads ARE at L2 and I get amazing relief. This is why I adamantly advise folks to make sure they are "buzzing" in their pain area before getting off the table (if at all possible). The standard location doesn't work for all.

    Do they have any idea how your leads migrated so far? I guess that was done a while ago before scarring down? Do you think it's been that way since the first few weeks?

    Take care,

    Cheri
  • Yes i have a good idea when it happened. About 10 weeks after implant. I bent over to pick up a piece of paper and left it pull. PM stated i pulled lead a little loose but she had no idea. She was apologizing big time Tues after the scope was done. Go in This coming Tues to get a better look and see what we can do
  • I've been all over the place trying to find
    anyone in the same 'predicament' I am in...

    rplatt56, if you are still here, could you let me know how you are doing? Your situation sounds almost exactly like what I'm going through.
    One of my leads has slipped down about 6 inches. Evidentally it pulled loose from the anchor and I have a feeling this happened at least 6 months ago.
    Since it has been this long, my fear is that the lead has scarred in.

    Just wondering how your revision went?
    Did your Dr have to cut the lead loose if it scarred in to the nearby tissue and if so, did you have to get a longer incision to rectify this?

    Nervous, but trying to be brave....
    Rae
  • I'm having a revision next month and might have an answer part of your question.

    My PM says that with just a little tug, the wires will break loose from the scar tissue and slide right out easily, with no additional incisions. I've had my implant for 2.5 years, so I was having nightmares about being sliced open all the way along the lead to get around the scar tissue. :o

    My PM will be working opposite of yours, since my paddle is staying put and everything else is moving, but that much should be the same.


  • Thank you SO much for responding BW!!
    I can not believe how difficult it is to find people to talk to about revisions due to lead migration, ESPECIALLY since migration is such a 'common' problem!
    Your reply has indeed helped! I hope it is as your Dr has implied. That would alleviate a LOT of my anxiety over this and I can see that you understand where my fear is coming from!! Big ((HUGS)) to you!

    The only people that I have been able to talk to about lead migration revisions say that it's no big deal.....and I'm sure they are right.....but MY big concern is the fact that it's been probably over 6 months that this lead has had a chance to 'grow' IN to the surrounding tissue and, like you mentioned, the realistic fear of having to get sliced open where the lead is to 'cut it loose' is what I've been desperately wanting to discuss with others who may have had similar experiences.
    I've literally been ALL OVER the internet looking for discussions on lead migration.
    I was getting so frustrated because I KNOW (from reading statistics) that this happens aLOT.....yet NO ONE seems to 'talk' about it!!

    I wish I could post my Xray showing that the lead has 2 kinks in it along the 6 inch path of the migration. I find it hard to believe that this is going to be a simple matter of pulling the lead back UP thru the original incision. If this had just recently happened, that would be different.

    I wish my doctor would talk to me like yours talked to you, giving better descriptions of what is going to take place. My doctor is one of those 'untouchables'......either because I can't get past his basket-case nurse, OR because he is always in surgery.

    Thank you so much for taking the time to respond.
    I wish there were more like you, who look 'beyond' the "oh it's no big deal"....and really 'SEE' that YES it IS a big deal! We have to get sliced BACK open and we aren't quite sure what they are going to find once they DO slice us back open!!
    I would say this IS certainly a BIG deal.

    Best Wishes to YOU on your revision!
    I will be on the lookout for your update
    You are a Godsend,
    Rae
  • I know for me, when I tell someone it is no big deal, I do that so they don't worry unnecessarily. In reality, at least for me, my initial fears are just that, initial fear of the unknown. Once I trudge on through to the other side, I can look back and see that it was no big deal. I trust my docs. I have great docs and they do have my best interests in mind. Because of that, I can allow them to have control over what happens or what doesn't happen.

    I've had two revisions, both were only 2 weeks apart. My leads did not migrate, however I was worried about that happening. I have torn my anchors loose and irritated my wires and IPG pocket enough to know that the small adhesions that form to scar in around everything, can tear loose quite easily.

    I've just learned that there's not much sense in making things out to be worse than they are. I also know that I am capable of making things worse by thinking or worrying that they "might" be worse. Kind of like a self fulfilling prophecy. So I do what I can to go forward thinking and hoping for the best and find out when I wake up which hand I have been dealt.

    Kindest Regards,

    "C"
  • Appreciate the feedback.
    Alot of my frustration over this is how difficult it has been in doing searches to find 'discussions' on revisions.
    I'm not a 'worry wort' by nature. I am in a situation where I have a doctor who doesn't communicate well at ALL. I was with him when he saw the Xrays and he was in as much 'shock' as I was and said it's been a 'long time' since he's had to do a revision (because he's so 'gooood' of course)....
    And then our visit was cut short because he needed his 'cigarette break' or whatever. And I've been left 'hanging' ever since....over 5 weeks.

    I have a friend who had a botched surgery and when I saw her post op pics, it looked like she had a zipper going down the entire length of her back. Now, hers was indeed a unique situation, not one to be considered a 'normal' revision. I've heard of a handful of cases where a patient goes in for what they 'think' is something intended to be no big deal, and they wake up with an incision 6 or 7 inches long.
    Not trying to 'scare' anyone or be a drama queen....I just want to connect with others who have had revisions.
    Thank you for sharing yours. By connecting with others, I will be able to know more of what to expect so I can have a decent discussion with my Dr without feeling like an uninformed pin cushion.

    I admit, it IS nice to be told it's no big deal for the sake of not worrying ... BUT I also want reality.
    I appreciate all your help and encouragement.

    Rae
  • I had a spinal fusion done in my lower back and it caused my SI joint to go bad. That was in oct 2012. On oct 2013 I had to
    he simulator implanted with the battery in my left check. I was told yesterday that they need to do a revision badd another lead and place something in my back to keep the wires from moving because they moved to the right. Right now I'm not getting the simulation in my lower back on both side where I need it and the battery site hurts and it is sticking up. But they said that it's good. I have burning in my back still from it to. I would like to know if the revision is worth it and if any one has had problems to. I don't need the simulation in my legs and ribs just my lower back and hips. I'm just really confused about enduring and have a short amount of time to figure this out.
  • edited 07/12/2015 - 11:24 AM
    Melanie hi Geraldine here I have had 5 revisions done.also I had to stay an extra night as the surgeon sniped on something and I was loosing spinal fluid headache for a few weeks After. All my revision where done because of every excuse was given to me by my surgan a kink In electricload . A connector slipping out because leads where short.and can go on.ya all was ok he had problems doing this revisions as far as I now it was the Medtronic equipment that was wrong.I had a bad fall 4 weeks ago and the leads has moved causing shocks all over my body causing a lot of pain.and discomfort. But by listening to him because it happend from a fall he might not be able to get my insurance company to cover me.But the question ill be asking why was he able to do it when it was their mistake. I think I may have to get my solicitor to talk to him and get some answers from Geraldine

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  • In December i had a spinal cord implant, when i awoke from the surgery i was in the worst pain of my life in the abdominal area. i am a 41 year old man, and i was balling because it was so severe.  bad...  the pain was in 3-5 second intervals. the pain meds they gave me worked for about 15 - 20 minutes, then it was back. 24 hours later the implant was removed. the only pain that was still their was the incision. the spinal column simulator got sent out for testing Dec 16th,  today is march 24th and still no answers on the test...
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