Retrospective Review of 707 Cases of Spinal Cord Stimulation: Indications and Complications

Abstract

Appropriate patient selection and minimizing complications are critical for successful spinal cord stimulation (SCS) therapy in managing intractable pain. We thus reviewed electronic medical records of 707 consecutive cases of patients who received SCS therapy in the Cleveland Clinic from 2000 to 2005 with an emphasis on indications and complications. SCS was used to treat complex regional pain syndrome (CRPS) (345 cases), failed back surgery syndrome (235 cases), peripheral vascular disease (20 cases), visceral pain in the chest, abdomen, and pelvis (37 cases), and peripheral neuropathy (70 cases). CRPS and failed back surgery syndrome accounted for 82% of the cases. The implant-totrial ratio was 75% on average, with the highest for CRPS type 2 (83%) and the lowest for peripheral vascular diseases (65%). The only documented complication associated with SCS trials was lead migration in 5 of 707 patients (0.7%). There were no permanent neurological deficits or deaths as a result of SCS implant or its complications. Hardware-related complications were common (38%) and included lead migration (22.6%), lead connection failure (9.5%), and lead breakage (6%). Revisions or replacements were required in these cases. Biologically related complications included pain at the generator site (12%) and clinical infection (4.5%; 2.5% with positive culture). The rates of infection varied among the different diagnoses with the highest in failed back surgery syndrome (6.3%). Patients with diabetes had an infection rate of 9%, over the 4% in non-diabetics. Infections were managed successfully with explantation and antibiotic therapy without permanent sequela.

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

“…In this series, more than 50% of revision cases required revisions due to nonfunc- tion of the SCS hardware, and this result is in agreement with the findings of previous reports. 6,14,22 Surprisingly, the percentage (2.1%) of lead migration was comparatively lower than that in an earlier report. 6 This finding can be explained by the following factors.…”

“…In our series, the complications rate was 36%, which is consistent with the findings of earlier studies with ranges from 31.6% to 54.6%. 6,14,22 The most common indications for revision were nonfunction or malfunction of the hardware, migration of the lead, and infection. In this series, more than 50% of revision cases required revisions due to nonfunc- tion of the SCS hardware, and this result is in agreement with the findings of previous reports.…”

Complications related to the use of spinal cord stimulation for managing persistent postoperative neuropathic pain after lumbar spinal surgery

“…Figure 1 presents an illustrative example of a patient implanted with such a device. With appropriately selected patients at centers with interdisciplinary expertise, the trial-to-implant conversion rates can be quite encouraging: in the 65%-80% range for various diagnoses, 15 although from a nationwide perspective, the actual conversion rate remains less encouraging at approximately 41%. 7 The utility of this technology has been demonstrated in prospective randomized and observational studies, and in systematic literature reviews for various pathologies, including PPNP after structurally corrective lumbar spinal surgery, 6 complex regional pain syndrome, 27 chronic inoperable limb ischemia, 31 treatment-refractory angina, 28 and painful diabetic neuropathy.…”

Spinal cord stimulation for chronic pain management: mini-review

“…1). The percutaneous technique can be ideal because it allows the placement of SCS without a surgical incision [11]. In addition, a percutaneous technique allows the testing of several spinal cord levels.…”

“…By placing multiple parallel electrodes into the epidural space, various configuration matrices can be constructed to stimulate painful dermatomes. On the other hand, a paddle electrode lead can be placed in the epidural space via open surgery (laminotomy or partial laminectomy), which provides greater stability and less predisposition to migrate [11,12].…”