Effectiveness of Cervical Spinal Cord Stimulation for the Management of Chronic Pain

Deer, Timothy R.; Skaribas, Ioannis; Haider, Nameer; Salmon, John F.; Kim, Chong; Nelson, Christopher Lee; Tracy, Jerry; Espinet, Anthony; Lininger, Todd E.; Tiso, Robert L.; Archacki, Melinda A.; Washburn, Stephanie N.

doi:10.1111/ner.12119

Cited by 62 publications

(71 citation statements)

References 23 publications

(19 reference statements)

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“…It has been shown to be efficacious 4,7,10,11,14,18,25,28,31,33,[35][36][37] and long-term complication rates are acceptable for surgery in the appropriate patient. In a systematic review of 180 cSCS patients across 10 studies with up to 88 months of follow-up after cSCS, the rate of hardware malfunction (17.8%), lead migration (13.9%), lead fracture (6.7%), pain over implant site (4.4%), infection (2.2%), over-or understimulation (1.1%), intermittent stimulation (0.5%), and other complications (8.3%) with the absence of any neurological injury supports a low long-term risk of cSCS.…”

Section: Discussionmentioning

confidence: 99%

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Rate of perioperative neurological complications after surgery for cervical spinal cord stimulation

Chan¹,

Winkler²,

Jacques³

2016

SPI

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OBJECTIVE Cervical spinal cord stimulation (cSCS) is used to treat pain of the cervical region and upper extremities. Case reports and small series have shown a relatively low risk of complication after cSCS, with only a single reported case of perioperative spinal cord injury in the literature. Catastrophic cSCS-associated spinal cord injury remains a concern as a result of underreporting. To aid in preoperative counseling, it is necessary to establish a minimum rate of spinal cord injury and surgical complication following cSCS. METHODS The Nationwide Inpatient Sample (NIS) is a stratified sample of 20% of all patient discharges from nonfederal hospitals in the United States. The authors identified discharges with a primary procedure code for spinal cord stimulation (ICD-9 03.93) associated with a primary diagnosis of cervical pathology from 2002 to 2011. They then analyzed short-term safety outcomes including the presence of spinal cord injury and neurological, medical, and general perioperative complications and compared outcomes using univariate analysis. RESULTS Between 2002 and 2011, there were 2053 discharges for cSCS. The spinal cord injury rate was 0.5%. The rates of any neurological, medical, and general perioperative complications were 1.1%, 1.4%, and 11.7%, respectively. There were no deaths. CONCLUSIONS In the largest series of cSCS, the risk of spinal cord injury was higher than previously reported (0.5%). Nonetheless, this procedure remains relatively safe, and physicians may use these data to corroborate the safety of cSCS in an appropriately selected patient population. This may become a key treatment option in an increasingly opioid-dependent, aging population.

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Section: Discussionmentioning

confidence: 99%

“…These include hardware malfunction, lead migration, lead fracture, implant site pain, infection, and nontherapeutic stimulation among others. 4,7,10,11,14,18,25,28,31,33,[35][36][37] Current small patient volume studies limit the detection of rare cSCS related complications and may lead to false safety assurances among implanters, clinicians, and patients.…”

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confidence: 99%

Rate of perioperative neurological complications after surgery for cervical spinal cord stimulation

Chan¹,

Winkler²,

Jacques³

2016

SPI

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“…Electrode‐lead revision rates in the present report were lower than what has been previously reported for any other studies that have a significant volume of implants and follow‐up period. Although there is no agreed‐upon best method of anchoring paddle electrodes , anchoring of paddle leads to soft tissues is generally performed by most cervical paddle implanters , including anchoring to the dura , although not clearly described in some reports . There have been no previous reports of an intentional nonanchoring method for cervical paddle or percutaneous electrodes in the literature, as described in the present report.…”

Section: Discussionmentioning

confidence: 74%

“…As part of a registry, Deer et al. reported a combined 13% revision rate for 38 cervical implants (10 paddles grouped into total with percutaneous lead implants) limited to less than a one‐year follow‐up period . Specific details of the kind of paddle implants and need(s) for revision were not available.…”

Section: Discussionmentioning

confidence: 99%

A Novel Nonanchoring Technique for Implantation of Paddle Leads in the Cervical Spine Under Conscious Sedation

Pahapill

2015

Neuromodulation: Technology at the Neural Interface

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“…A retrospective analysis of a prospectively maintained multicenter registry by Deer and colleagues, with a mean follow‐up of 88 months, found that cervical SCS was associated with enhanced pain relief, quality of life, and patient satisfaction, as well as a statistically significant improvement in pain disability index (PDI) in a group of 38 patients. However, only a small proportion of these patients (5/38) had undergone cervical SCS for a diagnosis of “failed neck surgery syndrome.” A more recent analysis of data from the EMPOWER and PAIN registries by Hunter and co‐authors, which assessed the use of cervical SCS in a group of 15 patients with “cervical failed back surgery syndrome,” found that mean patient‐reported percentage pain relief was 65%, 62%, and 72% at 3, 6, and 12 months postimplantation, respectively . Moreover, the mean PDI was significantly decreased at each of these 3 evaluated time points.…”

Section: Discussionmentioning

confidence: 99%

Spinal Cord Stimulation for Acute Pain Following Surgery for Cervical Myelopathy: A Novel Treatment Strategy

2018

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Background Chronic pain syndromes caused by degenerative and postinfectious changes in the cervical spine continue to pose significant management challenges to neurosurgeons and pain practitioners. The identification of an individualized treatment plan, astute surgical technique, comprehensive and multimodal analgesia, and adequate rehabilitation processes do not necessarily result in diminished pain. Case summary We present the case of a patient with chronic pain treated surgically for degenerative cervical myelopathy secondary to cervical spinal stenosis. Following this surgery, the patient experienced an intractable postoperative pain syndrome that had anatomical borders, and an intensity and character that were different from the background chronic pain from which he suffered. We successfully implanted a cervical spinal cord stimulation (SCS) lead in the period following his stenosis surgery, which had good therapeutic effect on the postoperative‐onset pain. To the best of our knowledge, this is the first description of SCS having a strong positive effect on an acute exacerbation of neuropathic pain. At follow‐up 12 months later, assessment of the patient's pain diary revealed a modal pain intensity of 3/10 on the numeric rating scale over the preceding 3 months. The Brief Pain Inventory (Short Form) scores at this time were 10/40 in the pain severity domain and 18/70 in the interference with function domain, demonstrating the long‐term effectiveness of this SCS strategy. Conclusion While SCS has hitherto been untested as a therapy for acute‐onset pain, this report demonstrates its utility as a salvage treatment in select cases of uncontrollable postoperative pain.

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Effectiveness of Cervical Spinal Cord Stimulation for the Management of Chronic Pain

Cited by 62 publications

References 23 publications

Rate of perioperative neurological complications after surgery for cervical spinal cord stimulation

Rate of perioperative neurological complications after surgery for cervical spinal cord stimulation

A Novel Nonanchoring Technique for Implantation of Paddle Leads in the Cervical Spine Under Conscious Sedation

Spinal Cord Stimulation for Acute Pain Following Surgery for Cervical Myelopathy: A Novel Treatment Strategy

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