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

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>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.</jats:p></jats:sec>

High-Frequency Spinal Cord Stimulation at 10 kHz for the Treatment of Combined Neck and Arm Pain: Results From a Prospective Multicenter Study

“…Lead migration leading to loss of efficacy, discomfort due to positioning of the leads (positional effect), and device related complications are commonly encountered in patients with upper limb and neck pain. 15-17 , 34 , 39 In the current study, only 1 in 45 subjects required an explant (2.2%) and there were no cases of lead migration or other complications despite positioning the leads at C2 vertebral level in all enrolled subjects. More importantly, all the device-related adverse events were manageable and resolved shortly after reprogramming.…”

Pain Relief and Safety Outcomes with Cervical 10 kHz Spinal Cord Stimulation: Systematic Literature Review and Meta-analysis

“…This notion may be reflected in the study by Al-Kaisy et al [ 18 ], where 10 kHz SCS devices were significantly less likely to be explanted relative to traditional stimulation [ 28 ]. Additionally, another potential concern with cervical SCS is the occurrence of neurological complications due to the complex anatomy surrounding the cervical spine [ 7 , 10 ]. None of the studies included in this review reported occurrence of neurological complications, indicating that such risks are minimal with 10 kHz SCS.…”

“…Stimulating the spinal cord through electrical impulses can create a neuromodulatory effect on the nervous system and can change the perception of pain in some patients [3,4]. Although traditional SCS has been used in practice for decades for chronic back and leg pain, favorable clinical results are becoming increasingly apparent for cervical SCS systems [3,[6][7][8][9][10][11]. The Neuromodulation Appropriateness Consensus Committee (NACC) recommends cervical SCS for the treatment of upper extremity pain since it is a safe, minimally invasive, and reversible procedure [12].…”

<p>Ten kilohertz SCS for Treatment of Chronic Upper Extremity Pain (UEP): Results from Prospective Observational Study</p>

“…[21][22][23] Lead migration is among the most concerning complications reported in prospective studies of cervical lead placement for management of pain. 7,[24][25][26][27] A systematic literature review of outcomes in patients with cervical SCS documented the rates for hardware malfunction (17.8%), lead migration (13.9%), lead fracture (6.7%), pain over implant site (4.4%) and infection (2.2%). 28 The AE rates reported in this study and in the previous studies evaluating 10 kHz SCS for upper limb and neck pain treatment compare favorably with the published literature…”