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Explantation of Spinal Cord Stimulators (California)

PostPosted: Mon Jul 14, 2014 6:29 am
by suekarp
I have an injured worker with a very long history of treatment for a neck, right shoulder injury - the injury date is 1989. He has undergone many surgeries, including cervical spine fusion, and at least 3 shoulder replacement/revision surgeries, with the last one being in October 2013. He had an intrathecal pump implanted in the mid 2000's, but, after he had the most recent shoulder revision, his need for pain medication has dropped very dramatically. However, he continues with persistant symptoms relative to anxiety, etc.

He also has a spinal cord stimulator in place, which has been turned off for the last several months. He would like to have it removed. However, he would also like to have the leads that are actually inserted into his intrathecal space, in addition to the battery back and spinal cord stimulator leads be taken out. The PTP is all for taking out the battery and the SCS leads, but he is not amenable to taking out the leads that are actually in the spinal canal because it could cause the need for neurosurgery. The applicant is insistant in taking the leads out at this surgical setting.

Do any of the fine medical minds have any insight into this issue? He is currently pro-per, and I do not think that any attorney would handle his claim at this late date?

Thank you for any insight that you can give to me.

Re: Explantation of Spinal Cord Stimulators (California)

PostPosted: Mon Jul 14, 2014 10:22 am
by LawAdvocate
Most triers-of-fact in the past would say you put them in, you take them out. However, given the physician recommendation this is a pure UR issue - the ultimate harm vs. benefit must be discussed. So first the applicant must find a surgeon who agrees that taking them out makes sense on a long term basis. I would say absent any harm in leaving them in, they stay in because the risks of taking them out and if the applicant later changes his minds and then wants them put back in are pretty substantial. I can't see any triers of fact allowing an agreement that says ok we take them out but Defendant never has to pay to put them back in, because they are an effective method of pain control. So does he want to settle with a Medicare set-aside, because Medicare will take them out, limiting your risk.

Re: Explantation of Spinal Cord Stimulators (California)

PostPosted: Mon Jul 14, 2014 11:23 am
by suekarp
I really have no objecting to taking out the battery and the SCS leads, but the lead that goes intrathecally seems to be more of a risk because it could result in a tear of the thecal sac, thereby putting the applicant in harms way, and possibly necessitating the need for neurosurgery. since he has numerous other problems, I'd like to avoid those, as well.

Re: Explantation of Spinal Cord Stimulators (California)

PostPosted: Mon Jul 14, 2014 2:47 pm
by LawAdvocate
Agreed, so do you have a request to take out what he wants taken out? Then you have to defer to UR and see what happens. But since the surgeon is not recommending it, you do not need to provide this until he finds a physician willing to take it out who sends a valid RFA and then you send that to UR.

Re: Explantation of Spinal Cord Stimulators (California)

PostPosted: Tue Jul 15, 2014 6:01 am
by suekarp
Thanks, Law!

Re: Explantation of Spinal Cord Stimulators (California)

PostPosted: Tue Feb 03, 2015 6:57 pm
by dolphines
I don't know if you've went through with it, but i have a spinal cord simulator, have since 2007. i have had it revised several times, and am about to have the leads moved up, to cover the spread of the rsd.

My doctor is taken everything out, except the battery pack, and is going to pit in a trial one, located out of my body. This is a temporary one, to see if it works. if it does, the he will hook it all back together, just up higher. No big deal about moving it around, or revising it, just have to be careful with rsd spreading, and watch out for infections.

if you have any questions, fell free to ask.

Re: Explantation of Spinal Cord Stimulators (California)

PostPosted: Wed Feb 11, 2015 7:15 am
by suekarp
Just a quick update - We did go through the process of taking the SCS out. It was causing the applicant additional pain, rather than doing anything good. Now I have an issue with the PTP stating that the leads should not be taken out, but the applicant's Kaiser physicians are telling the applicant that the leads should also come out.

Ee also had an intrathecal pump taken out.

Re: Explantation of Spinal Cord Stimulators (California)

PostPosted: Wed Feb 26, 2020 8:43 pm
by 4anewusers
This was from several years ago and I am curious what the final result was.

I also would like to know if this patient had leads or paddles inserted ?

When paddles are inserted it is a much more invasive surgery, it involves a laminectomy and can be difficult to remove paddles.

When leads are inserted usually (not always) it does not involve a laminectomy. Spinal cord stimulators have a 30%-40% complication rate with lead migration being number one. Paddles are implanted on the spine so they cannot move, while leads are free floating. Both the leads and the paddles can cause pain and why doctors remove them, but some doctors are not comfortable removing paddles. I would also not recommend having a pain management doctor implant or explant paddles, and would recommend a spinal surgeon. I know pain management doctors are implanting spinal cord stimulators, but that doesn't mean they should be.(JMO)