Abstract
Introduction: Spinal cord stimulation (SCS) is an effective treatment for patients with refractory chronic pain. Despite its efficacy, rates of reoperation after initial implantation of SCS remain high. While revision rates after index SCS surgeries are well reported, less is known about rates and risk factors associated with repeat reoperations. We sought to evaluate patient, clinical, and surgical characteristics associated with repeat reoperation among patients who underwent an initial SCS revision procedure. Methods: We performed a retrospective review of patients who underwent SCS revision surgery performed at a single institution between 2008 and 2022. Patients were stratified by whether they underwent a single revision (SR) or multiple revision (MR) surgeries. Multivariate logistic regression was performed to determine risk factors associated with repeat SCS revision. Kaplan-Meier survival analysis was used to compare rates of devices requiring revision across groups. Results: A total of 54 patients underwent an initial SCS revision. Of these, 15 (28%) underwent a second revision. The most common indication for revision surgery was lead migration (65%). No significant differences were observed in age, body mass index, comorbidities, lead type, and revision indication among the SR and MR groups. On multivariate adjusted analysis, only cervical lead position was significantly associated with repeat reoperation (OR 7.10, 95% CI [1.14, 44.3], p = 0.036). Time to reoperation after a single and MR SCS surgeries did not differ. Conclusions: Among patients who undergo SCS reoperation, a substantial portion requires additional revisions. Cervical lead placement may be associated with a higher risk of repeat revision surgery compared to thoracic lead positioning. Consideration of lead positioning in the decision to perform and undergo reoperation may therefore result in lower revision rates and improved clinical outcomes among SCS patients with MRs.
Journal Section:
Clinical Study
References
1.
Cohen
SP
, Vase
L
, Hooten
WM
. Chronic pain: an update on burden, best practices, and new advances
. Lancet
. 2021
;397
(10289
):2082
–97
. 2.
Rock
AK
, Truong
H
, Park
YL
, Pilitsis
JG
. Spinal cord stimulation
. Neurosurg Clin N Am
. 2019
;30
(2
):169
–94
. 3.
Kumar
K
, Taylor
RS
, Jacques
L
, Eldabe
S
, Meglio
M
, Molet
J
, et al. Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomised controlled trial in patients with failed back surgery syndrome
. Pain
. 2007
;132
(1–2
):179
–88
. 4.
Kumar
K
, Taylor
RS
, Jacques
L
, Eldabe
S
, Meglio
M
, Molet
J
, et al. The effects of spinal cord stimulation in neuropathic pain are sustained: a 24-month follow-up of the prospective randomized controlled multicenter trial of the effectiveness of spinal cord stimulation
. Neurosurgery
. 2008
;63
(4
):762
–70
; discussion 770. 5.
Manca
A
, Kumar
K
, Taylor
RS
, Jacques
L
, Eldabe
S
, Meglio
M
, et al. Quality of life, resource consumption and costs of spinal cord stimulation versus conventional medical management in neuropathic pain patients with failed back surgery syndrome (PROCESS trial)
. Eur J Pain
. 2008
;12
(8
):1047
–58
. 6.
Kemler
MA
, Barendse
GA
, van Kleef
M
, de Vet
HC
, Rijks
CP
, Furnée
CA
, et al. Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy
. N Engl J Med
. 2000
;343
(9
):618
–24
. 7.
Mannheimer
C
, Eliasson
T
, Andersson
B
, Bergh
CH
, Augustinsson
LE
, Emanuelsson
H
, et al. Effects of spinal cord stimulation in angina pectoris induced by pacing and possible mechanisms of action
. BMJ
. 1993
;307
(6902
):477
–80
. 8.
Falowski
SM
, Tan
H
, Parks
J
, Abd-Elsayed
A
, Raslan
A
, Pope
J
. Anticipating and preventing complications in spinal cord stimulator implantation
. Expert Rev Med Devices
. 2023
;20
(5
):365
–72
. 9.
Turner
JA
, Loeser
JD
, Deyo
RA
, Sanders
SB
. Spinal cord stimulation for patients with failed back surgery syndrome or complex regional pain syndrome: a systematic review of effectiveness and complications
. Pain
. 2004
;108
(1–2
):137
–47
. 10.
Eldabe
S
, Buchser
E
, Duarte
RV
. Complications of spinal cord stimulation and peripheral nerve stimulation techniques: a review of the literature
. Pain Med
. 2016
;17
(2
):325
–36
. 11.
Blackburn
AZ
, Chang
HH
, DiSilvestro
K
, Veeramani
A
, McDonald
C
, Zhang
AS
, et al. Spinal cord stimulation via percutaneous and open implantation: systematic review and meta-analysis examining complication rates
. World Neurosurg
. 2021
;154
:132
–43 e1
. 12.
Shamji
MF
, Westwick
HJ
, Heary
RF
. Complications related to the use of spinal cord stimulation for managing persistent postoperative neuropathic pain after lumbar spinal surgery
. Neurosurg Focus
. 2015
;39
(4
):E15
. 13.
Negoita
S
, Duy
PQ
, Mahajan
UV
, Anderson
WS
. Timing and prevalence of revision and removal surgeries after spinal cord stimulator implantation
. J Clin Neurosci
. 2019
;62
:80
–2
. 14.
Manchikanti
L
, Pampati
V
, Vangala
BP
. Spinal cord stimulation trends of utilization and expenditures in fee-for-service (FFS) medicare population from 2009 to 2018
. Pain Physician
. 2021
;24
(5
):293
–308
.15.
Russo
M
, Cousins
MJ
, Brooker
C
, Taylor
N
, Boesel
T
, Sullivan
R
, et al. Effective relief of pain and associated symptoms with closed-loop spinal cord stimulation system: preliminary results of the Avalon Study
. Neuromodulation
. 2018
;21
(1
):38
–47
. 16.
Kapural
L
, Yu
C
, Doust
MW
, Gliner
BE
, Vallejo
R
, Sitzman
BT
, et al. Comparison of 10-kHz high-frequency and traditional low-frequency spinal cord stimulation for the treatment of chronic back and leg pain: 24-month results from a multicenter, randomized, controlled pivotal trial
. Neurosurgery
. 2016
;79
(5
):667
–77
. 17.
von Elm
E
, Altman
DG
, Egger
M
, Pocock
SJ
, Gøtzsche
PC
, Vandenbroucke
JP
, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies
. Lancet
. 2007
;370
(9596
):1453
–7
. 18.
Dasenbrock
HH
, Yan
SC
, Smith
TR
, Valdes
PA
, Gormley
WB
, Claus
EB
, et al. Readmission after craniotomy for tumor: a National surgical quality improvement program analysis
. Neurosurgery
. 2017
;80
(4
):551
–62
. 19.
Antonovich
DD
, Gama
W
, Ritter
A
, Wolf
BJ
, Nobles
RH
, Selassie
MA
, et al. Reoperation rates of percutaneous and paddle leads in spinal cord stimulator systems: a single-center retrospective analysis
. Pain Med
. 2021
;22
(1
):34
–40
. 20.
Dhruva
SS
, Murillo
J
, Ameli
O
, Morin
PE
, Spencer
DL
, Redberg
RF
, et al. Long-term outcomes in use of opioids, nonpharmacologic pain interventions, and total costs of spinal cord stimulators compared with conventional medical therapy for chronic pain
. JAMA Neurol
. 2023
;80
(1
):18
–29
. 21.
Deer
TR
, Russo
M
, Grider
JS
, Pope
J
, Hagedorn
JM
, Weisbein
J
, et al. The neurostimulation appropriateness consensus committee (NACC): recommendations on best practices for cervical neurostimulation
. Neuromodulation
. 2022
;25
(1
):35
–52
. 22.
Chivukula
S
, Tempel
ZJ
, Weiner
GM
, Gande
AV
, Chen
CJ
, Ding
D
, et al. Cervical and cervicomedullary spinal cord stimulation for chronic pain: efficacy and outcomes
. Clin Neurol Neurosurg
. 2014
;127
:33
–41
. 23.
Sayed
D
, Salmon
J
, Khan
TW
, Sack
AM
, Braun
T
, Barnard
A
, et al. Retrospective analysis of real-world outcomes of 10 kHz SCS in patients with upper limb and neck pain
. J Pain Res
. 2020
;13
:1441
–8
. 24.
Chivukula
S
, Tomycz
ND
, Moossy
JJ
. Paddle lead cervical spinal cord stimulation for failed neck surgery syndrome
. Clin Neurol Neurosurg
. 2013
;115
(10
):2254
–6
. 25.
North
RB
, Recinos
VR
, Attenello
FJ
, Shipley
J
, Long
DM
. Prevention of percutaneous spinal cord stimulation electrode migration: a 15-year experience
. Neuromodulation
. 2014
;17
(7
):670
–7
; discussion 676–7. 26.
Dougherty
MC
, Woodroffe
RW
, Wilson
S
, Gillies
GT
, Howard III
MA
, Carnahan
RM
. Risk factors and survival analysis of spinal cord stimulator explantation
. Neuromodulation
. 2021
;24
(1
):61
–7
. 27.
Taylor
RS
, Desai
MJ
, Rigoard
P
, Taylor
RJ
. Predictors of pain relief following spinal cord stimulation in chronic back and leg pain and failed back surgery syndrome: a systematic review and meta-regression analysis
. Pain Pract
. 2014
;14
(6
):489
–505
. 28.
Kumar
K
, Toth
C
, Nath
RK
, Laing
P
. Epidural spinal cord stimulation for treatment of chronic pain: some predictors of success. A 15-year experience
. Surg Neurol
. 1998
;50
(2
):110
–21
; discussion 120–1. 29.
Slyer
J
, Scott
S
, Sheldon
B
, Hancu
M
, Bridger
C
, Pilitsis
JG
. Less pain relief, more depression, and female sex correlate with spinal cord stimulation explants
. Neuromodulation
. 2020
;23
(5
):673
–9
. 30.
Van Buyten
JP
, Wille
F
, Smet
I
, Wensing
C
, Breel
J
, Karst
E
, et al. Therapy-related explants after spinal cord stimulation: results of an International retrospective chart review study
. Neuromodulation
. 2017
;20
(7
):642
–9
. 31.
Conic
RRZ
, Caylor
J
, Cui
CL
, Reyes
Z
, Nelson
E
, Yin
S
, et al. Sex-specific differences in the efficacy of traditional low frequency versus high frequency spinal cord stimulation for chronic pain
. Bioelectron Med
. 2022
;8
(1
):8
. 32.
Kumar
K
, Hunter
G
, Demeria
D
. Spinal cord stimulation in treatment of chronic benign pain: challenges in treatment planning and present status, a 22-year experience
. Neurosurgery
. 2006
;58
(3
):481
–96
; discussion 481–96. 33.
Plesh
O
, Adams
SH
, Gansky
SA
. Racial/Ethnic and gender prevalences in reported common pains in a national sample
. J Orofac Pain
. 2011
;25
(1
):25
–31
.34.
Patel
SK
, Gozal
YM
, Saleh
MS
, Gibson
JL
, Karsy
M
, Mandybur
GT
. Spinal cord stimulation failure: evaluation of factors underlying hardware explantation
. J Neurosurg Spine
. 2020
;32
:133
–8
. 35.
Hussain
N
, Boulos
R
, Malik
TM
, Abd-Elsayed
A
, Essandoh
MK
, Khan
S
, et al. Identifying predictors for early percutaneous spinal cord stimulator explant at one and two years: a retrospective database analysis
. Neuromodulation
. 2023
;26
(1
):124
–30
. 36.
De La Cruz
P
, Fama
C
, Roth
S
, Haller
J
, Wilock
M
, Lange
S
, et al. Predictors of spinal cord stimulation success
. Neuromodulation
. 2015
;18
(7
):599
–602
; discussion 602. 37.
Celestin
J
, Edwards
RR
, Jamison
RN
. Pretreatment psychosocial variables as predictors of outcomes following lumbar surgery and spinal cord stimulation: a systematic review and literature synthesis
. Pain Med
. 2009
;10
(4
):639
–53
. 38.
Olson
KA
, Bedder
MD
, Anderson
VC
, Burchiel
KJ
, Villanueva
MR
. Psychological variables associated with outcome of spinal cord stimulation trials
. Neuromodulation
. 1998
;1
(1
):6
–13
. 39.
Sheng
J
, Liu
S
, Wang
Y
, Cui
R
, Zhang
X
. The link between depression and chronic pain: neural mechanisms in the brain
. Neural Plast
. 2017
;2017
:9724371
. 40.
Beletsky
A
, Liu
C
, Alexander
E
, Hassanin
SW
, Vickery
K
, Loomba
M
, et al. The association of psychiatric comorbidities with short-term and long-term outcomes following spinal cord stimulator placement
. Neuromodulation
. 2023
;26
(5
):1081
–8
. 41.
Paroli
M
, Bernini
O
, De Carolis
G
, Tollapi
L
, Bondi
F
, Martini
A
, et al. Are multidimensional pain inventory coping strategy profiles associated with long-term spinal cord stimulation effectiveness
. Pain Med
. 2018
;19
(5
):1023
–32
. 42.
Fama
CA
, Chen
N
, Prusik
J
, Kumar
V
, Wilock
M
, Roth
S
, et al. The use of preoperative psychological evaluations to predict spinal cord stimulation success: our experience and a review of the literature
. Neuromodulation
. 2016
;19
(4
):429
–36
. 43.
Leplus
A
, Voirin
J
, Cuny
E
, Onno
M
, Billot
M
, Rigoard
P
, et al. Is spinal cord stimulation still effective after one or more surgical revisions
. Neuromodulation
. 2023
;26
(5
):1102
–8
. 44.
Bir
SC
, Konar
S
, Maiti
T
, Nanda
A
, Guthikonda
B
. Neuromodulation in intractable pain management: outcomes and predictors of revisions of spinal cord stimulators
. Neurosurg Focus
. 2016
;40
(5
):E4
. 45.
Mehta
SH
, Hoelscher
CM
, Sharan
AD
, Thalheimer
S
, Wu
C
. Implantable pulse generator site may be associated with spinal cord stimulation revision surgeries
. Neuromodulation
. 2021
;24
(8
):1336
–40
. 46.
Nissen
M
, Ikaheimo
TM
, Huttunen
J
, Leinonen
V
, von Und Zu Fraunberg
M
. Long-term outcome of spinal cord stimulation in failed back surgery syndrome: 20 years of experience with 224 consecutive patients
. Neurosurgery
. 2019
;84
(5
):1011
–8
. 47.
West
T
, ElSaban
M
, Hussain
N
, Schappell
J
, Rogers
K
, Orhurhu
V
, et al. Incidence of lead migration with loss of efficacy or paresthesia coverage after spinal cord stimulator implantation: systematic review and proportional meta-analysis of prospective studies and randomized clinical trials
. Neuromodulation
. 2023
;26
(5
):917
–27
. 48.
Hayek
SM
, Veizi
E
, Hanes
M
. Treatment-limiting complications of percutaneous spinal cord stimulator implants: a review of eight years of experience from an academic center database
. Neuromodulation
. 2015
;18
(7
):603
–9
; discussion 608–9. 49.
Turner
JA
, Loeser
JD
, Bell
KG
. Spinal cord stimulation for chronic low back pain: a systematic literature synthesis
. Neurosurgery
. 1995
;37
(6
):1088
–96
; discussion 1095–6. 50.
Rosenow
JM
, Stanton-Hicks
M
, Rezai
AR
, Henderson
JM
. Failure modes of spinal cord stimulation hardware
. J Neurosurg Spine
. 2006
;5
(3
):183
–90
. 51.
Cameron
T
. Safety and efficacy of spinal cord stimulation for the treatment of chronic pain: a 20-year literature review
. J Neurosurg
. 2004
;100
(3 Suppl Spine
):254
–67
. 52.
Teton
ZE
, Blatt
D
, AlBakry
A
, Obayashi
J
, Ozturk
G
, Hamzaoglu
V
, et al. Natural history of neuromodulation devices and therapies: a patient-centered survival analysis
. J Neurosurg
. 2020
;132
(5
):1385
–91
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