Removal of spinal cord stimulator epidural array Removal of spinal cord stimulator generator Thoracic laminectomy for epidural abscess Deep spinal infection incision and drainage and debridement and layered complex closure of postoperative wound infection

PREOPERATIVE DIAGNOSES:

1.  Status post spinal cord stimulator, epidural array implantations.

2.  Spinal cord stimulator generator implantation.

3.  History of previous infection about the spinal cord stimulator, epidural array with recurrent infection and epidural abscess at the site of the spinal cord stimulator, epidural array.

POSTOPERATIVE DIAGNOSES:

1.  Status post spinal cord stimulator, epidural array implantations.

2.  Spinal cord stimulator generator implantation.

3.  History of previous infection about the spinal cord stimulator, epidural array with recurrent infection and epidural abscess at the site of the spinal cord stimulator, epidural array.

OPERATION PERFORMED:

1.  Removal of spinal cord stimulator, epidural array.

2.  Removal of spinal cord stimulator generator.

3.  Thoracic laminectomy for epidural abscess.

4.  Deep spinal infection incision and drainage and debridement.

5.  _____ layered complex closure of postoperative wound infection.

ANESTHESIA:  General.

INDICATIONS:  The patient is a 77-year-old woman.  Refer to my previously dictated clinical note at which point, I discussed indications of procedures, risks, benefits, and expected outcomes.  The dictation number for that is #2683505.

PROCEDURE IN DETAIL:  After obtaining informed consent, the patient was taken to the operating room.  After induction of general endotracheal anesthesia, the patient was positioned prone on the Jackson table.  All pressure points were carefully padded.  The back was prepped and draped in the usual sterile fashion.  The incision of the spinal cord stimulator generator was opened up sharply with #10 scalpel.  The incision had been drained copious amounts of fluid.  The generator was easily explanted.  There was a significant amount of grungy-appearing tissue, which was bluntly and sharply dissected.  The skin edges were sharply resected with #11 scalpel.

I opened up the midline thoracic incision approximately 5 inches of the cranial most portion of the incision with a #10 scalpel, carried down with electrocautery to the fascia.  We identified the spinal cord stimulator electrode extension.  These were followed cranially to the laminotomy site.

With meticulous dissection, I was able to gently tease the scar at the laminotomy site off of the dura.  There was egress of significant amount of epidural pus.  The epidural array was easily removed.  Next, I extended the laminotomy cranially with Kerrison rongeurs with an elevator was used to probe the epidural space to ensure there is no evidence for any residual epidural abscess both cranially and caudally.  There is no evidence for any residual epidural pus.  Next, I irrigated out the epidural space with antibiotic-impregnated saline.  Meticulous hemostasis was obtained.  Next, I irrigated the thoracic incision copiously with antibiotic-impregnated saline with pulse lavage.  Meticulous hemostasis was obtained with cautery.  Hemovac drain placed in epidural space, brought by separate stab incision.  Next, a meticulous multiple layer closure was performed with 0 PDS suture for the fascia and muscle, subcutaneous tissues in layers 2-0 PDS suture, and skins were approximated with 3-0 nylon in interrupted mattress fashion.  Next, I previously debrided the pocked from the spinal cord stimulator generator. I placed the drain into the depths of the incision.  I closed the dead space with 0 PDS sutures, subcutaneous tissues in layers with 2-0 PDS suture, and interrupted stitch of 3-0 nylon in mattress fashion for the skin.  Sterile dressing were applied followed by an Ioban drape dressing.

The patient was next carefully transferred to a hospital stretcher and awoken from anesthesia, extubated and taken to the recovery room in stable condition.

Estimated blood loss was approximately 50 mL.  Specimen was cultures from the epidural space as well as from the spinal cord stimulator generator pocket as well as spinal cord stimulator generator and epidural array.  No complications.  No change in baseline evoked potentials.  The patient tolerated the procedure well.