{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T22:25:08Z","timestamp":1766787908697,"version":"3.40.5"},"reference-count":13,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,6,15]],"date-time":"2021-06-15T00:00:00Z","timestamp":1623715200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pain Practice"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Spinal cord stimulation (SCS) is commonly utilized for treatment and management of chronic intractable low back and lower extremity pain. Although SCS is an overall low\u2010risk procedure, there are potential life\u2010threatening complications, including surgical site infections, such as an epidural abscess. Immunosuppression, a risk factor for epidural abscess, is becoming more common as an increasing number of patients are being treated with biologics for a multitude of autoimmune disorders. One class of commonly utilized biologics is antitumor necrosis factor (anti\u2010TNF) alpha. Whereas these drugs can provide tremendous benefit for treatment and management of autoimmune disorders, there is no clear understanding of the degree to which these medications increase a patient\u2019s risk for surgical site infection, including those associated with SCS\u2010related procedures. We present a case of an epidural abscess that developed immediately following an SCS trial in a patient with multiple undisclosed risk factors, including the use of an anti\u2010TNF alpha agent to treat ankylosing spondylitis. For an epidural abscess, early diagnosis is key to preventing devastating complications and the need for surgical intervention. Immunosuppression can be the result of multiple issues including cancer, HIV, and biologic agents, such as anti\u2010TNF alpha for the management of autoimmune diseases. There is limited evidence pertaining to the development of epidural abscesses in patients on anti\u2010TNF alpha medications who undergo SCS. Studies focused on infections in patients undergoing SCS trials and permanent implants while on anti\u2010TNF alpha agents could provide recommendations and guidance.<\/jats:p>","DOI":"10.1111\/papr.13025","type":"journal-article","created":{"date-parts":[[2021,5,2]],"date-time":"2021-05-02T09:51:58Z","timestamp":1619949118000},"page":"113-116","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Antitumor necrosis factor alpha and an epidural abscess during a spinal cord stimulator trial: A case report"],"prefix":"10.1111","volume":"22","author":[{"given":"Andrew","family":"Frazier","sequence":"first","affiliation":[{"name":"Department of Anesthesiology University of Kansas Medical Center Kansas City Kansas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9406-9241","authenticated-orcid":false,"given":"Walter N.","family":"Orr","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology University of Kansas Medical Center Kansas City Kansas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward","family":"Braun","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology University of Kansas Medical Center Kansas City Kansas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,6,15]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.21.4.105"},{"key":"e_1_2_5_3_1","unstructured":"Bureau of Labor Statistics.Lost\u2010worktime injuries and illnesses: characteristics and resulting time away from work. USDL 02\u2010196. United States Department of Labor.2002.https:\/\/www.bls.gov\/iif\/oshwc\/osh\/case\/osnr0015.pdf. Accessed April 1 2021."},{"issue":"3","key":"e_1_2_5_4_1","first-page":"254","article-title":"Safety and efficacy of spinal cord stimulation for the treatment of chronic pain: a 20\u2010year literature review","volume":"100","author":"Cameron T","year":"2004","journal-title":"J Neurosurg"},{"issue":"2","key":"e_1_2_5_5_1","first-page":"325","article-title":"Complications of spinal cord stimulation and peripheral nerve stimulation techniques: a review of the literature","volume":"17","author":"Eldabe A","year":"2016","journal-title":"Pain"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2017.07.017"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/PL00011954"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000002875"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcm100"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.3171\/foc.2004.17.6.12"},{"issue":"3","key":"e_1_2_5_11_1","first-page":"430","article-title":"Complication rates of 127 surgical procedures performed in rheumatic patients receiving tumor necrosis factor alpha blockers","volume":"25","author":"Ruyssen\u2010Witrand A","year":"2007","journal-title":"Clin Exp Rheumatol"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fcl.2007.04.005"},{"volume-title":"Medicijnen: het toepassen van TNF blokkade in de behandeling van reumato\u00efde artritis","year":"2004","author":"Dutch Society for Rheumatology","key":"e_1_2_5_13_1"},{"key":"e_1_2_5_14_1","first-page":"689","article-title":"Risk factors for surgical site infections and other complications in elective surgery in patients with rheumatoid arthritis with special attention for anti\u2010tumor necrosis factor: a large retrospective study","volume":"34","author":"Broeder AA","year":"2007","journal-title":"J Rheumatol"}],"container-title":["Pain Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/papr.13025","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/papr.13025","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/papr.13025","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,25]],"date-time":"2023-08-25T20:53:59Z","timestamp":1692996839000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/papr.13025"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,15]]},"references-count":13,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,1]]}},"alternative-id":["10.1111\/papr.13025"],"URL":"https:\/\/doi.org\/10.1111\/papr.13025","archive":["Portico"],"relation":{},"ISSN":["1530-7085","1533-2500"],"issn-type":[{"type":"print","value":"1530-7085"},{"type":"electronic","value":"1533-2500"}],"subject":[],"published":{"date-parts":[[2021,6,15]]},"assertion":[{"value":"2021-02-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-04-27","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-06-15","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}