Long-term safety of spinal cord stimulation systems in a prospective, global registry of patients with chronic pain

Aim: The availability of long-term (>2 years) safety outcomes of spinal cord stimulation (SCS) remains limited. We evaluated safety in a global SCS registry for chronic pain. Methods: Participants were prospectively enrolled globally at 79 implanting centers and followed out to 3 years after device implantation. Results: Of 1881 participants enrolled, 1289 received a permanent SCS implant (1776 completed trial). The annualized rate of device explant was 3.5% (all causes), and 1.1% due to inadequate pain relief. Total incidence of device explantation >3 years was 7.6% (n = 98). Of these, 32 subjects (2.5%) indicated inadequate pain relief as cause for removal. Implant site infection (11 events) was the most common device-related serious adverse event (<1%). Conclusion: This prospective, global, real-world study demonstrates a high-level of safety for SCS with low rate of explant/serious adverse events. Clinical Trial Registration: NCT01719055 (ClinicalTrials.gov).

Reoperation Rates of Percutaneous and Paddle Leads in Spinal Cord Stimulator Systems: A Single-Center Retrospective Analysis

OBJECTIVE

We hypothesize that reoperation rates of spinal cord stimulation (SCS) systems utilizing percutaneous leads are comparable to those utilizing paddle leads. We attempt here to characterize causes for those reoperations and identify any related patient characteristics.

DESIGN AND SUBJECTS

This study is a single-center retrospective chart review of 291 subjects (410 operations) who underwent at least one permanent SCS implantation utilizing percutaneous or paddle leads over a 10-year period at the Medical University of South Carolina.

METHODS

Charts were reviewed for height, weight, body mass index, gender, race, age, stimulator type, type of reoperation, diabetes status, history and type of prior back surgery, top lead location, and number of leads placed. Comparisons of patient and procedural characteristics were conducted using a two-sample t test (continuous variables), chi-square, or Fisher exact approach (categorical variables). Univariate and multivariate Cox regression models were developed, identifying associations between patient characteristics, SCS characteristics, reoperation rates, and time to reoperation.

RESULTS

Thirty point five eight percent of subjects (89/291), required at least one reoperation. The reoperation rate was 27.84% for percutaneous systems (N = 54/194) and 27.78% for percutaneous systems (N = 60/216). Time to reoperation also did not differ between the two systems (hazard ratio [HR] = 1.06, 95% CI = 0.70-1.60). Of all factors examined, younger age at time of placement was the only factor associated with risk of reoperation (HR = 0.73, 95% CI = 0.62-0.87, P < 0.001).

CONCLUSIONS

Our data suggest that reoperation rates and time to reoperation between percutaneous and paddle leads are clinically similar; therefore, rates of reoperation should have no bearing on which system to choose.

Impact of continuous paravertebral blockade infusion type on pain management over time for video-assisted thoracoscopic surgery: a pilot study

This pilot study was designed to examine the impact of two different (PVB) infusion types compared to a control (no PVB) on pain management in video-assisted thoracoscopic surgery. Acute and chronic pain over time, perioperative oral morphine milligram equivalent (MME) consumption and patient satisfaction were measured. A protracted enrollment period and participant attrition precluded target enrollment and subsequent power analysis. Further, there was no increased efficacy of the intervention groups over the control group. In fact, the patient-controlled analgesia only group (control) had lower mean and median MME consumption postoperatively. Pain and patient satisfaction scores were similar among all treatment groups at all time points assessed. We characterize our study population, report our results for each treatment group and highlight challenges encountered and lessons learned to aid in the development of future research.