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Efficacy and Complications Profile of Surgically Implanted Versus Percutaneously Implanted Spinal Cord Stimulation Systems

Efficacy and Complications Profile of Surgically Implanted Versus Percutaneously Implanted Spinal Cord Stimulation Systems

Anesthesiology Abstracts of Scientific Papers Annual Meeting: Abstract No. A-928

INTRODUCTION: Spinal cord stimulation is an effective treatment for intractable chronic pain. Earlier, comparisons of percutaneous and surgical approaches showed better long-term effect of the surgically implanted leads1,2. Recently, with the improvement in lead design and extensive experience percutaneous techniques of stimulation may be more efficacious. METHODS: 34 patients who underwent percutaneous placement (P-SCS) and 28 who had placement of the insulated four-contact array by laminectomy/laminotomy surgery (S-SCS) were retrospectively studied. All of them completed trial of SCS with decrease of their pains of more than 50%. Mean follow-up was 24.6 months. Patients average ages were 47 and 47.2 years, respectively. Chart review and interviews were used to asses efficacy, complications and narcotic use. RESULTS: Of 34 P-SCS patients 27 still used their stimulators (80%), while 22 of 28 (78.5%) S-SCS patients continued to use SCS at the time of last follow-up. 27 P-SCS patients who continued using their SCS system had a VAS mean change from 9.2 to 4.3 at 1 year following implant while in S-SCS patients scores decreased in average from 9 to 4.3. Both methods produced more than 50% pain relief and were not statistically different. Area of the SCS paresthesias subjectively covered the painful area by 84.4% in P-SCS group and 87.9% in S-SCS group and that area decreased in size 1 year following implant by 13.1% and 6.8%, respectively which was not significantly different. At the same time decrease of the opioid use of 50% or more was noted in 74 % of P-SCS patients and 59% of S-SCS patients. There was only one perioperatively recorded complication in each of the groups. Postoperatively 37 % of the P-SCS patients suffer from any of the complications (most frequent lead migration and headache) and 45% of the S-SCS patients (most frequent nonfunctioning lead and infection). Of those who still used SCS system 11 of 27 in P-SCS group and 11 of 22 in S-SCS group needed to undergo second surgical procedure for either revision or generator replacement. DISCUSSION: Although there is a significant patient population requiring surgical placement of the lead for SCS via laminectomy/laminotomy route, majority of the patients may have comparable results when leads implanted percutaneously. P-SCS is as effective as S-SCS, however, it is associated with less morbidity and shorter hospital stay.

Accession: 034833010

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