{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T16:55:08Z","timestamp":1791305708578,"version":"4.3.1"},"reference-count":16,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pain Practice"],"published-print":{"date-parts":[[2026,11]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Surgical site infections (SSI) associated with spinal cord stimulation (SCS) implants pose risks of morbidity, mortality, and increased healthcare costs. Immunocompromised patients are especially vulnerable due to impaired immune responses, delaying diagnosis and increasing complications. Current guidelines recommend SCS explantation for deep or inadequately treated superficial SSI, though the role of capsulectomy remains underexplored despite its use in other fields like plastic surgery and cardiology.<\/jats:p>\n <\/jats:sec>\n \n Case Presentation<\/jats:title>\n \n We present two cases of immunocompromised patients with SSI treated with SCS explantation and capsulectomy. Case 1 involved a 64\u2010year\u2010old woman with ulcerative colitis and psoriatic arthritis treated with immunosuppressive agents who developed fever and myalgia and had normal imaging. Despite treatment with a course of antibiotics, she developed granulation tissue at the midline incision which tracked to the lead anchors. Explantation revealed necrotic tissue, and capsulectomy of the implanted pulse generator pocket and around lead anchors was performed.\n \n Staphylococcus schleiferi<\/jats:italic>\n <\/jats:styled-content>\n , likely linked to pet exposure, was identified. Case 2 involved a 52\u2010year\u2010old woman with postlaminectomy syndrome and rheumatoid arthritis on immunosuppressants, who presented with erythema and wound dehiscence weeks post\u2010implant. Explantation and capsulectomy were performed to remove fibrotic tissue potentially harboring biofilm. MRSA infection was identified. Targeted antibiotics facilitated recovery in both cases.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n These cases suggest capsulectomy during SCS explantation may mitigate complications, particularly in immunocompromised patients. Current guidelines recommend capsule debridement but do not routinely address capsulectomy; its use may improve infection resolution in high\u2010risk populations, perhaps by eliminating biofilm associated with the capsule.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/papr.70212","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T16:18:37Z","timestamp":1791303517000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Capsulectomy at Explant: Rethinking Spinal Cord Stimulator Infected Generator Pocket Management in the Immunocompromised\u2014A Case Series"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3792-3987","authenticated-orcid":false,"given":"Tigran","family":"Kesayan","sequence":"first","affiliation":[{"name":"Department of Anesthesiology Vanderbilt University Medical Center Nashville Tennessee USA"},{"name":"Department of Neurology Vanderbilt University Medical Center Nashville Tennessee USA"},{"name":"Department of Plastic Surgery Vanderbilt University Medical Center Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7738-4901","authenticated-orcid":false,"given":"Vida","family":"Motamedi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Vanderbilt University Medical Center Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Hanflink","sequence":"additional","affiliation":[{"name":"Nova Southeastern University College of Osteopathic Medicine Fort Lauderdale Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Assi","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Vanderbilt University Medical Center Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salam","family":"Kassis","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Vanderbilt University Medical Center Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"e_1_2_11_2_1","article-title":"ASRA Pain Medicine Consensus Practice Infection Control Guidelines for Regional Anesthesia and Pain Medicine","author":"Provenzano D. 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A.","year":"2019","journal-title":"Neuromodulation"},{"key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"2147","DOI":"10.2147\/JPR.S509623","article-title":"Device Evaluation, Treatment, and Explantation Recommendations (DETER): Review and Best Practices for Managing Neuromodulation Device Infections","volume":"18","author":"Pritzlaff S. G.","year":"2025","journal-title":"Journal of Pain Research"},{"issue":"1","key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1111\/ner.13263","article-title":"Outcomes Associated With Infection of Chronic Pain Spinal Implantable Electronic Devices: Insights From a Nationwide Inpatient Sample Study","volume":"24","author":"Goel V.","year":"2021","journal-title":"Neuromodulation: Technology at the Neural Interface"},{"issue":"1","key":"e_1_2_11_9_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13017-021-00375-y","article-title":"Surgical Site Infection Prevention and Management in Immunocompromised Patients: A Systematic Review of the Literature","volume":"16","author":"Coccolini F.","year":"2021","journal-title":"World Journal of Emergency Surgery"},{"key":"e_1_2_11_10_1","article-title":"Breast Implant Illness: Treatment Using Total Capsulectomy and Implant Removal","volume":"22","author":"Metzinger S. E.","year":"2022","journal-title":"Eplasty"},{"issue":"1","key":"e_1_2_11_11_1","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1007\/s10840-019-00581-4","article-title":"Effect of Fibrotic Capsule Debridement During Generator Replacement on Cardiac Implantable Electronic Device Infection Risk","volume":"58","author":"Goldenberg G. R.","year":"2020","journal-title":"Journal of Interventional Cardiac Electrophysiology"},{"key":"e_1_2_11_12_1","doi-asserted-by":"crossref","DOI":"10.1177\/01455613251349619","article-title":"A Case of Canine\u2010Transmitted Postoperative \n Staphylococcus schleiferi\n Sinusitis","author":"Cabrera H. 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A.","year":"2017","journal-title":"Neuromodulation"}],"container-title":["Pain Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/papr.70212","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/papr.70212","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/papr.70212","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T16:18:40Z","timestamp":1791303520000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/papr.70212"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,6]]},"references-count":16,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["10.1111\/papr.70212"],"URL":"https:\/\/doi.org\/10.1111\/papr.70212","archive":["Portico"],"relation":{},"ISSN":["1530-7085","1533-2500"],"issn-type":[{"value":"1530-7085","type":"print"},{"value":"1533-2500","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,6]]},"assertion":[{"value":"2025-11-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70212"}}