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Spinal Cord Stimulator Explantation: Motives for Removal of Surgically Placed Paddle Systems
Author(s) -
Dupré Derrick A.,
Tomycz Nestor,
Whiting Donald,
Oh Michael
Publication year - 2018
Publication title -
pain practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 58
eISSN - 1533-2500
pISSN - 1530-7085
DOI - 10.1111/papr.12639
Subject(s) - medicine , spinal cord stimulator , surgery , weakness , magnetic resonance imaging , spinal cord , paddle , spinal cord stimulation , retrospective cohort study , radiology , mechanical engineering , psychiatry , engineering
Background Despite requiring successful trials prior to implantation, spinal cord stimulation ( SCS ) systems for pain are often later removed. Removing surgically implanted hardware subjects patients to the risks and discomfort of a second surgery, threatens the cost‐effectiveness of SCS , and limits the perceived durability of SCS technology for pain problems. Objective To investigate patterns of reasons given among patients who underwent SCS explant surgery ( SCSES ). Methods Retrospective review of SCSES cases over 17 years at Allegheny General Hospital, Pittsburgh, PA . Results 165 patients underwent SCSES between 1997 and 2014. The top 3 reasons for explantation were inadequate pain control ( IPC ; 73%), hardware discomfort (22%), and need for magnetic resonance imaging ( MRI ) (10%). Other less frequent reasons were infection (9%), painful dysesthesias (9%), electrical arcing (4%), resolution of inciting symptoms (4%), weakness (2%), pseudomeningocele (1%) and muscle spasms (1%). Conclusion Inadequate pain control is the most common reason for SCSES . Advances in technology are needed to improve the quality and duration of pain control, as well as to design improvements to make the hardware more comfortable. A significant number of implants are removed due to need for MRI , a fact obviating the need for MRI ‐compatible systems. Patients considering SCS paddle lead placement should be counseled on the most common reasons for later explantation.