You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

Long-term Outcomes After Replacement of Percutaneous Leads With Paddle Leads in a Retrospective Cohort of Patients With Spinal Cord Stimulation Systems

Matias, Caio M. MD*; Amit, Amit MD*; Lempka, Scott F. PhD; Ozinga, John G. IV MSPAS, PA-C; Nagel, Sean J. MD; Lobel, Darlene A. MD; Machado, Andre G. MD, PhD

Neurosurgery:
doi: 10.1227/NEU.0000000000000460
Research-Human-Clinical Studies
Abstract

BACKGROUND: Although the long-term outcomes for spinal cord stimulation (SCS) have been reported, long-term outcomes of patients who underwent revisions of the SCS with paddle leads are lacking.

OBJECTIVE: To report the long-term outcomes of 39 patients who had percutaneous SCS revised with a new paddle lead.

METHODS: Baseline and follow-up mail-in questionnaires assessed pain and disability levels with numerical rating scales, somatotopical overlap between SCS-related paresthesias and areas of chronic pain, and overall satisfaction. Analysis was performed with regard to age, sex, diagnosis, duration of disease, number of surgical revisions, complications, and interval between surgeries.

RESULTS: After surgical revision, 20 patients (50%) had at least a 3-point reduction in the numerical rating scale. Greater pain reduction was correlated with better coverage (P = .001). Coverage area was greater in patients with a single revision than in patients with multiple revisions (P = .01). Good satisfaction was reported by 25 patients (62.5%) who indicated that they would undergo the procedure again in order to achieve the same results. These patients had significantly greater pain reduction (P = .001) and better coverage (P = .002) than patients who reported otherwise. No other major complication occurred.

CONCLUSION: Revision of percutaneous SCS systems with implantation of a new paddle lead is safe and more effective in patients who have undergone not more than 1 prior revision.

ABBREVIATIONS: CRPS, complex regional pain syndrome

FBSS, failed back surgery syndrome

IQR, interquartile range

MR, multiple revisions

NRS, numerical rating scale

SCS, spinal cord stimulation

SD, standard deviation

SR, single revision

Author Information

Center for Neurological Restoration, Cleveland Clinic Neurological Institute, Cleveland, Ohio

Correspondence: Andre G. Machado, MD, PhD, Center for Neurological Restoration, Cleveland Clinic Neurological Institute, 9500 Euclid Ave, Cleveland, OH 44195. E-mail: machada@ccf.org

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.neurosurgery-online.com).

* These authors contributed equally.

Received February 24, 2014

Accepted May 26, 2014

Copyright © by the Congress of Neurological Surgeons