Neuromodulation in intractable pain management: outcomes and predictors of revisions of spinal cord stimulators

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Spinal cord stimulators (SCSs) appear to be safe and efficacious for chronic intractable back pain. Although there are many reports on percutaneous SCSs, there are very few studies on outcomes of paddle lead SCSs. In addition, the predictors of requirement for SCS revision have not been well established. Here, the authors review the outcome of a case series and attempt to identify the predictors of SCS revisions.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The clinical and radiological information of 141 patients with intractable chronic pain who underwent SCS implantation within the past 20 years was retrospectively reviewed. Paddle lead SCSs were used in this series. Statistical analysis was conducted using Kaplan-Meier curves and Cox proportional-hazards regression.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Among 141 cases, 90 (64%) did not require any revision after SCS implantations. Removal of the SCS was required in 14 patients. The average pain score was significantly reduced (preimplantation score of 8 vs postimplantation score of 1.38; p &lt; 0.0001). Younger age, male sex, obesity, a preimplantation pain score ≥ 8, and the presence of neuromuscular pain were identified as predictors of the overall requirement for SCS revision. However, only a preimplantation pain score ≥ 8 was identified as a predictor of early failure of the SCS.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Implantation of a paddle lead SCS is a relatively less invasive, safe, and effective procedure for patients with intractable back pain. Revision of the procedure depends on many factors, including younger age, male sex, associated neuromuscular pain, and severity of the pain. Therefore, patients with these factors, for whom implantation of an SCS is planned, should be closely followed for the possible requirement for revision.</jats:p></jats:sec>

Drivers and Risk Factors of Unplanned 30-Day Readmission Following Spinal Cord Stimulator Implantation

“…Accordingly, a link between obesity and post-operative complications after spinal cord stimulator implantation has been established in the literature. 22,23 Marola et al reported a higher complication rate among patients with BMI > 36.5 in a retrospective review of 77 patients undergoing SCS implantation. 23 Similarly, in a retrospective study of 141 patients undergoing SCS implantation for chronic pain syndrome, Bir et al found that BMI > 30 kg/m 2 was predictive of need for early revision after surgery due to mechanical complications such as hardware malfunction or lead migration.…”

“…23 Similarly, in a retrospective study of 141 patients undergoing SCS implantation for chronic pain syndrome, Bir et al found that BMI > 30 kg/m 2 was predictive of need for early revision after surgery due to mechanical complications such as hardware malfunction or lead migration. 22 These mechanical complications are likely attributable to technical challenges inherent to operating on obese patients, as patient positioning and tissue depth can interfere with lead and generator placement. 23,24 In addition to mechanical complications, high BMI has been linked with increased post-operative infections after spinal surgery.…”

“…Obesity poses unique risks both from a technical and infectious standpoint during implantation of spinal cord stimulators. Accordingly, a link between obesity and postoperative complications after spinal cord stimulator implantation has been established in the literature (22,23). Marola et al reported a higher complication rate among patients with BMI > 36.5 in a retrospective review of 77 patients undergoing SCS implantation (23).…”

Pain Remission at One-Year Follow-Up With Spinal Cord Stimulation

“…However, even with this trial process, after permanent implantation, only 48% of patients who receive SCS for FBSS achieved 50% or greater pain relief at long‐term follow‐up visit . Evidence has also shown that higher body mass index (BMI), smoking, and drug use may impede benefits . Psychological factors may also play a role, though individual measures of psychological function have not been reproduced .…”

Spinal cord stimulation for chronic pain management: mini-review

“…In addition, it is suitable for patients requiring higher amplitudes of stimulation. Recently, the rechargeable pulse generator has been used widely because of its small size and ease of maintenance [14,15].…”