Risk Factors and Survival Analysis of Spinal Cord Stimulator Explantation

Dougherty, Mark C.; Woodroffe, Royce W.; Wilson, Saul; Gillies, G. T.; Howard, Matthew A.; Carnahan, Ryan M.

doi:10.1111/ner.13173

Cited by 20 publications

(19 citation statements)

References 20 publications

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“…This is in line with a previous study of van Buyten et al reporting annual explantation rate of 8% during a median follow-up of 2.2 years (37). In a recent study, Dougherty et al reported a lower 10% explantation rate due to non-infectious reasons in five-year follow-up (38). Patients with unsuccessful long-term implants are in high risk of psychiatric and other comorbidities (39).…”

Section: Discussionsupporting

confidence: 88%

Higher Preimplantation Opioid Doses Associated With Long-Term Spinal Cord Stimulation Failure in 211 Patients With Failed Back Surgery Syndrome

Nissen

Ikäheimo

Huttunen

et al. 2021

Neuromodulation: Technology at the Neural Interface

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Objective Spinal cord stimulation (SCS) is an effective treatment in failed back surgery syndrome (FBSS). We studied the effect of preimplantation opioid use on SCS outcome and the effect of SCS on opioid use during a two‐year follow‐up period. Materials and methods The study cohort included 211 consecutive FBSS patients who underwent an SCS trial from January 1997 to March 2014. Participants were divided into groups, which were as follows: 1) SCS trial only (n = 47), 2) successful SCS (implanted and in use throughout the two‐year follow‐up period, n = 131), and 3) unsuccessful SCS (implanted but later explanted or revised due to inadequate pain relief, n = 29). Patients who underwent explantation for other reasons (n = 4) were excluded. Opioid purchase data from January 1995 to March 2016 were retrieved from national registries. Results Higher preimplantation opioid doses associated with unsuccessful SCS (ROC: AUC = 0.66, p = 0.009), with 35 morphine milligram equivalents (MME)/day as the optimal cutoff value. All opioids were discontinued in 23% of patients with successful SCS, but in none of the patients with unsuccessful SCS (p = 0.004). Strong opioids were discontinued in 39% of patients with successful SCS, but in none of the patients with unsuccessful SCS (p = 0.04). Mean opioid dose escalated from 18 ± 4 MME/day to 36 ± 6 MME/day with successful SCS and from 22 ± 8 MME/day to 82 ± 21 MME/day with unsuccessful SCS (p < 0.001). Conclusions Higher preimplantation opioid doses were associated with SCS failure, suggesting the need for opioid tapering before implantation. With continuous SCS therapy and no explantation or revision due to inadequate pain relief, 39% of FBSS patients discontinued strong opioids, and 23% discontinued all opioids. This indicates that SCS should be considered before detrimental dose escalation.

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Section: Discussionsupporting

confidence: 88%

Higher Preimplantation Opioid Doses Associated With Long-Term Spinal Cord Stimulation Failure in 211 Patients With Failed Back Surgery Syndrome

Nissen

Ikäheimo

Huttunen

et al. 2021

Neuromodulation: Technology at the Neural Interface

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“…While explant rates of 6.7% to 23.9% have been described in the literature for traditional SCS, the long-term (12+ months) explant rates of 10 kHz-SCS have been questioned (6)(7)(8)(9). This prompted the authors to evaluate their own practices and critically review their own outcomes with 10 kHz-SCS.…”

Section: Introductionmentioning

confidence: 99%

Explantation of 10 kHz Spinal Cord Stimulation Devices: A Retrospective Review of 744 Patients Followed for at Least 12 Months

Hagedorn

Lam

D’Souza

et al. 2021

Neuromodulation: Technology at the Neural Interface

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“…Approximately 50,000 new spinal cord stimulators are implanted worldwide annually (9). As the rate of SCS implants continues to rise, pain physicians need to be well-equipped to manage its complications.…”

Section: Discussionmentioning

confidence: 99%

Cerebrospinal Fluid Leak Following Explantation of Percutaneous Spinal Cord Stimulator Device: A Case Report

Nguyen¹,

Nguyen²,

Evazyan³

2022

PMCR

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BACKGROUND: While spinal cord stimulation (SCS) is a safe and effective treatment for chronic pain, some patients require explantation of their devices due to complications or inadequate pain control. The rate of SCS implantation has steadily increased over the years; however, the complications of percutaneous lead extraction have not been well-documented in the scientific literature. CASE REPORT: We present an 86-year-old patient at our institution who developed an intraoperative cerebrospinal fluid (CSF) leak during SCS explantation. The leak was conservatively managed with tight surgical closure and placement of an abdominal binder. The patient tolerated the procedure well and only developed a minor headache which self-resolved. CONCLUSION: Although rare, SCS lead extraction can cause CSF leakage from unintentional intraoperative dural tear. While most CSF leaks can be managed conservatively and do not require surgical repair, pain physicians need to be well-informed on how to manage CSF leaks that occur during SCS explantation. KEY WORDS: Case report, cerebrospinal fluid leak, chronic pain, explantation, spinal cord stimulation

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Risk Factors and Survival Analysis of Spinal Cord Stimulator Explantation

Cited by 20 publications

References 20 publications

Higher Preimplantation Opioid Doses Associated With Long-Term Spinal Cord Stimulation Failure in 211 Patients With Failed Back Surgery Syndrome

Higher Preimplantation Opioid Doses Associated With Long-Term Spinal Cord Stimulation Failure in 211 Patients With Failed Back Surgery Syndrome

Explantation of 10 kHz Spinal Cord Stimulation Devices: A Retrospective Review of 744 Patients Followed for at Least 12 Months

Cerebrospinal Fluid Leak Following Explantation of Percutaneous Spinal Cord Stimulator Device: A Case Report

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