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Treatment-Limiting Complications of Percutaneous Spinal Cord Stimulator Implants: A Review of Eight Years of Experience From an Academic Center Database
Objective
The study aims to evaluate the long‐term implant survival and complications of spinal cord stimulation (SCS) leading to surgical revision or explant in patients treated for chronic noncancer pain.
Materials and Methods
This is a retrospective study of all patients who underwent a percutaneous spinal cord stimulation trial followed by implant in an academic Pain Medicine division by four practitioners from 2007 to 2013, with follow‐up data through April 2014.
Results
A total of 345 patients were considered candidates for dorsal column stimulation and underwent a trial. Two hundred thirty‐four patients were implanted with an implant‐to‐trial ratio of 67–86% across various chronic pain entities (postlaminectomy syndrome, complex regional pain syndrome, small‐fiber peripheral neuropathy, abdominal/pelvic pain, nonsurgical candidates with lumbosacral neuropathy, and neuropathic pain not otherwise specified), with the exception of nonsurgical candidates with lumbosacral neuropathy who had an implant ratio of 43%. The complication rate was 34.6%, with the hardware related being the most common reason, comprising 74.1% of all complications. The revision and explant rates were 23.9% each. The most common reason for explant was loss of therapeutic effect (41.1%).
Conclusions
SCS is an effective treatment for chronic noncancer pain. It is a minimally invasive procedure, safe, and with good long‐term outcomes. However, the surgical revision and explant rates are relatively high. As the use of SCS continues to grow, research into the causes of and risk factors for SCS‐related complications is paramount to decrease complication rates in the future.