SCS emergencies

Intra-spinal abscess with neurological deficit and deep surgical site infection.

Acute loss of efficacy may cause significant distress and should be managed promptly.

It is worth noting that dorsal root ganglion (DRG) stimulation wires are especially fragile and prone to such complications

Disconnect the epidural leads anchored in the lumbar fascia and then connected to the IPG/battery
A proprietary screwdriver is needed to disconnect the battery from leads.
Removing the stimulator requires first dissecting out the anchors, then pulling out the epidural leads and finally removing the IPG.
Avoid transecting the wires leaving orphaned epidural leads in situ as these will then be very difficult to remove and would also preclude any future MRI imaging.
Diathermy

Conventional monopolar diathermy should not damage the insulated wires, but should be avoided with an SCS system in situ(19) due to both the risk of thermal injury as well as potential damage to apparatus.
Bipolar diathermy can be used safely.
Pulsed radiofrequency (RF) energy devices such as the Medtronic Plasmablade operate at a significantly lower temperature than conventional monopolar diathermy and are routinely used

It should be however be noted that, excepting Medtronic DBS battery replacement, other uses are off-licence.

Of the neuromodulation systems SCS are the most susceptible to thermal damage so additional precautions including a lower power setting and avoiding direct contact with the apparatus etc. are advised

Although more expensive, these are much less likely to damage wiring than sharp dissection.