Abstract
Objectives
Spinal cord stimulation (SCS) is burdened with surgical complications that may require
one or several surgical revision(s), challenging its risk/benefit ratio and cost-effectiveness.
Our objective was to evaluate its outcome and efficacy after one or more SCS surgical
revisions.
Materials and Methods
We identified and retrospectively analyzed 116 patients treated by tonic paresthesia-based
SCS who experienced one or more complication(s) requiring at least one surgical revision.
Data collected included initial indication, revision indication, number of revisions,
and lead design (paddle or percutaneous). Outcome after SCS revision was evaluated
by pain intensity decrease (comparing baseline and postrevision Numerical Rating Scale
[NRS] scores) and percentage of patients reporting pain relief ≥50%. Outcome was analyzed
according to the number of surgical revisions and the revision indications.
Results
Most of the patients (61%) underwent only one revision (mean delay after implantation
44 months). The most frequent causes of revisions were hardware dysfunction (32%),
lead migration (23%), and infection (18%). Revision(s) repaired the SCS issue in 87%
of the cases. One year after the first revision, 82% of the patients reported pain
relief ≥50%, and the mean NRS decrease was 4.0 compared with baseline (p < 0.001). Benefit of SCS revision tended to decrease with the number of revisions
but did not differ across revision indications. No serious surgical complications
related to the revision occurred, except for three hematomas occurring after repeated
revisions.
Conclusions
Our data suggest that surgical revision of SCS system is safe and led to significant
pain relief in most of the cases, provided that the initial indication was good and
that the previous stimulation was effective. However, success of SCS revision decreases
with the number of revisions.
Keywords
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Comments
Article info
Publication history
Published online: April 19, 2023
Accepted:
March 1,
2023
Received in revised form:
March 1,
2023
Received:
January 9,
2023
Publication stage
In Press Corrected ProofFootnotes
Source(s) of financial support: The authors reported no funding sources.
Conflict of Interest: Aurelie Leplus has received speaker fees from Boston Scientific. Denys Fontaine is consultant for Medtronic, Boston Scientific, and Abbott and has received research grants from Abbott and Medtronic, outside the present study. Jimmy Voirin is consultant for Medtronic and Boston Scientific and has received fees from Medtronic and Boston Scientific. Philippe Rigoard reports grants and personal fees from Medtronic, Abbott, and Boston Scientific, outside the submitted work. The remaining authors reported no conflict of interest.
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© 2023 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.
