Abstract
INTRODUCTION
Spinal cord stimulation (SCS) is commonly used to treat various forms of chronic pain. For some patient, the initial benefit is short lived and they return for device removal. The aims of this study are to identify reasons for SCS explantation and to analyze the circumstances of implantation to identify improvement opportunities for appropriate patient selection and prediction of successful clinical response to the therapy.
METHODS
This is a retrospective review of 178 patients who underwent SCS explantation over the past 9 yr.
RESULTS
The most common reason for explantation was a lack of efficacy. Of the 178 patients that received explantation, 141 (79%) indicated that lack of efficacy played a role, 31 (17%) discomfort, 20 (11%) side effects, 22 (12.4%) infection, and 24 (13.5%) expressed the need for an MRI. More than one factor prompted explantation for 33% of these patients (n = 58). A diagnosis of various types of chronic pain without failed back surgery syndrome (FBSS) was the most common diagnosis made up 63% (n = 72/115) of explants, while patients with FBSS made up 37% (n = 43/115). The average SCS trial duration of patients receiving explants was 5.016 d. When comparing the average duration of a permanent SCS implant with the length of a SCS trial, a shorter trial length corresponded with a longer permanent implant duration. SCS trials lasting less than and greater than or equal to five days resulted in an average permanent implant duration of 36.5 mo (n = 25) and 20 mo (n = 38), respectively (alpha = 0.05, P = .0166).
CONCLUSION
Identifying opportunities for more appropriate patient selection for SCS will increase success rate of the therapy and reduce the number of explants. This may be possible through closer consideration of pain presentation and surgical history, as well as a re-evaluation of trialing methods for SCS.
Practical considerations and patient selection for intrathecal drug delivery in the management of chronic pain
