Incidence of Clinically Significant Percutaneous Spinal Cord Stimulator Lead Migration

Gazelka, Halena M.; Freeman, Eric D.; Hooten, W. Michael; Eldrige, Jason S.; Hoelzer, Bryan C.; Mauck, William D.; Moeschler, Susan M.; Pingree, Matthew J.; Rho, Richard H.; Lamer, Tim J.

doi:10.1111/ner.12184

Cited by 54 publications

(40 citation statements)

References 12 publications

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“…These leads have been shown to present with lower long‐term migration rates than percutaneous leads and lesser need for reoperation . In accordance with our results, there is now evidence that rates of lead‐related adverse events requiring surgical revision are lower using new SCS hardware …”

Section: Discussionsupporting

confidence: 89%

Evaluation of the Effectiveness of Percutaneous Octapolar Leads in Pain Treatment with Spinal Cord Stimulation of Patients with Failed Back Surgery Syndrome During a 1‐Year Follow‐Up: A Prospective Multicenter International Study

2016

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Section: Discussionsupporting

confidence: 89%

Evaluation of the Effectiveness of Percutaneous Octapolar Leads in Pain Treatment with Spinal Cord Stimulation of Patients with Failed Back Surgery Syndrome During a 1‐Year Follow‐Up: A Prospective Multicenter International Study

2016

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“…Additional inclusion criteria were: 18 years of age, 1-year follow-up time prior to permanent implantation, and 1-year follow-up time after index event. For the purposes of multivariate regression analysis, patient cohort was further divided into high (>25), medium (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24), and low (3-8) volume providers to delineate any relationship between provider volumes on explantation rates. Within the Market-Scan Database, data coding prior to 2009 does not distinguish between revision and total explant.…”

Section: Patient Populationmentioning

confidence: 99%

“…The ability to predict patient-by-patient success of SCS involves a variety of factors, including the success of trial implant, judicious patient selection, and postprocedure programming (13)(14)(15)(16)(17)(18)(19)(20)(21). Nevertheless, lead migration and device failure are possible complications that can produce patient dissatisfaction (22)(23)(24)(25). When SCS fails or becomes refractory over time, patients and providers must decide whether to leave the device in place or to remove the device through an explantation procedure.…”

Section: Introductionmentioning

confidence: 99%

Explantation Rates and Healthcare Resource Utilization in Spinal Cord Stimulation

Han

Murphy

Hussaini

et al. 2017

Neuromodulation: Technology at the Neural Interface

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OBJECTIVES Certain patients ultimately undergo explantation of their spinal cord stimulation (SCS) devices. Understanding the predictors and rates of SCS explantation has important implications for healthcare resource utilization (HCRU) and pain management. The present study identifies explant predictors and discerns differences in HCRU for at-risk populations. METHODS We designed a large, retrospective analysis using the Truven MarketScan Database. We included all adult patients who underwent a SCS trial from 2007 to 2012. Patients were grouped into cohorts that remained explant-free or underwent explantation over a 3-year period, and multivariate models evaluated differences in healthcare resource utilization. RESULTS A total of 8,727 unique instances of trial implants between 2007 and 2012 were identified. Overall, 805 (9.2%) patients underwent device explantation. One year prior to SCS implantation, the explant cohort had significantly higher median baseline costs ($42,140.3 explant vs. $27,821.7 in non-explant groups; p<0.0001), total number of pain encounters (180 vs. 103 p<0.0001), and associated costs ($15,446.9 vs. $9,227.9; p<0.0001). The explant cohort demonstrated increased use of procedures (19.0 vs. 9.0; p<0.0001) compared to non-explanted patients. For each month after initial SCS implantation, explanted patients had a slower decrease in total costs (4% vs. 6% in non-explant; p<0.01). At the month of explant, explant patients were expected to have incurred 2.65 times the total cost compared to the non-explant cohort (CR 2.65, 95% CI [1.83, 3.84]; p<0.001). Medium volume providers had lower rates of explantation at 1-year and 3-years compared to low volume providers (p=0.042). Increased age and Charlson index were independent predictors of explantation during the same periods. CONCLUSIONS In this nationwide analysis, we identified that SCS device explantation is correlated with patients who have higher baseline costs, higher total cost post-SCS implantation, and increased use of procedures to control pain. The higher rates of explantation at 3-years post-implant among low volume providers suggest that variations in provider experience and approach also contributes to differences in explantation rates.

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“…8 Lead migration is a common problem leading to early complications, as recent studies have identified a prevalence of 13–22% of migrations occuring. 11,17 Early interventions to reduce this complication included the advent of multi-contact electrode arrays, along with percutaneous and laminotomy-guided lead placement; while migration rates lowered after these advances, the problem still persists. 18 In a comparison study of 13,774 patients who underwent SCS implantation with paddle versus percutaneous leads, Babu et al demonstrated that patients receiving paddle leads were more likely to have greater initial postoperative complications, but were associated with a significantly lower long-term reoperation rate when compared to patients who received the percutaneous leads.…”

Section: Discussionmentioning

confidence: 99%

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

Elsamadicy

Sergesketter

Ren

et al. 2018

Neuromodulation: Technology at the Neural Interface

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Our study suggests that infectious and mechanical complications are the primary drivers of unplanned 30-day readmission after SCS implantation, with obesity as an independent predictor of unplanned readmission. Given the technological advancements in SCS, repeated studies are necessary to identify factors associated with unplanned 30-day readmission rates after SCS implantation to improve patient outcomes and reduce associated costs.

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Incidence of Clinically Significant Percutaneous Spinal Cord Stimulator Lead Migration

Cited by 54 publications

References 12 publications

Evaluation of the Effectiveness of Percutaneous Octapolar Leads in Pain Treatment with Spinal Cord Stimulation of Patients with Failed Back Surgery Syndrome During a 1‐Year Follow‐Up: A Prospective Multicenter International Study

Evaluation of the Effectiveness of Percutaneous Octapolar Leads in Pain Treatment with Spinal Cord Stimulation of Patients with Failed Back Surgery Syndrome During a 1‐Year Follow‐Up: A Prospective Multicenter International Study

Explantation Rates and Healthcare Resource Utilization in Spinal Cord Stimulation

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

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