Open AccessPredictors of Spinal Cord Stimulation Success
Author(s) -
De La Cruz Priscilla,
Fama Christopher,
Roth Steven,
Haller Jessica,
Wilock Meghan,
Lange Steven,
Pilitsis Julie
Publication year - 2015
Publication title -
neuromodulation: technology at the neural interface
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.296
H-Index - 60
eISSN - 1525-1403
pISSN - 1094-7159
DOI - 10.1111/ner.12325
Subject(s) - medicine , depression (economics) , spinal cord stimulation , body mass index , cohort , prospective cohort study , retrospective cohort study , physical therapy , surgery , stimulation , economics , macroeconomics
As many as 30% of spinal cord stimulation ( SCS ) patients fail to obtain long‐term pain coverage, even with the strictest parameters of a successful trial, unremarkable psychological assessment, and ideal placement of the permanent device. Why these patients either never receive adequate benefit or lose benefit remains elusive. Methods We perform a retrospective review of our prospective database of SCS patients undergoing surgery for routine indications. Six‐month postoperative follow‐up data were available for 57 patients. Two providers who routinely saw the patients were asked to independently grade the patient's outcome in a blinded fashion on a G lobal O utcome Ratings scale of 1 to 10, with 5 being 50% improvement at 6 months postoperation. A score of less than 5 was deemed a failure. The impact of body mass index ( BMI ), random drug screen results, workers' compensation status, depression, and smoking were assessed. Results We report a phi correlation of 0.350 between smoking and failure ( p = 0.017). Smoking status is correlated with both lead migration revisions (phi = 0.269) ( p = 0.044) and with revision due to new pain symptoms (phi = 0.241) ( p = 0.072). Further, there is a trend of correlation (phi = 0.289) between drug use and patients ( N = 3) who underwent device removal ( p = 0.045). In this cohort, worker's compensation status, BMI , and depression did not impact outcome. Conclusions Tobacco use correlates with less success with SCS at 6‐month follow‐up. Whether that is because of issues with healing and our transmission of signals to the periphery warrants further exploration. These data provide further evidence that tobacco cessation is important to surgical results.