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26th Napa Pain Conference

NPC26-Sa4-B - Salvaging Spinal Cord Stimulation Failures


Aug 17, 2019 11:00am ‐ Aug 17, 2019 12:30pm


Description


Salvaging Spinal Cord Stimulation Failures


Target Audience: Clinicians implanting, managing, or identifying patients for SCS therapy


Learning Objectives

As a result of participating in this activity, learners will be better able to:

  • Compare and contrast technical differences of neurostimulation devices
  • Apply an improved understanding of SCS parameters to patient selection and trialing


Presentations

Tolerance & Loss of Efficacy

David Provenzano, MD

Surgical Revisions vs. Program Revisions

Corey W. Hunter, MD

Developing Electrophysiological Models of Disease

Peter S. Staats, MD, MBA, FIPP



Description

A recent studies have shown that 34% of patients with a spinal cord stimulator (SCS) will undergo surgical revision of the implant with a median time to first revision of 16 months. Additionally, 30-53% of patients with a SCS device will have the device explanted with a median time to removal of 39 months.

The most common explanations for explant are: ineffective pain control or lack/loss of efficacy (28-43.9%%), followed by biological complications (20.2-26.6%), paresthesia limitation or side effects (26.6%), and hardware complications/device malfunction (13.3-46%).

High variations in specialty-based trial-to-implant ratios for implanting physicians indicate opportunities for improvement with patient selection, surgical technique, and technical understanding of SCS mechanisms of action.



Additional Reading

  • Hussaini, S. M. Q., Murphy, K. R., Han, J. L., Elsamadicy, A. A., Yang, S., Premji, A., ... & Lad, S. P. (2017). Specialty‐based variations in spinal cord stimulation success rates for treatment of chronic pain. Neuromodulation: Technology at the Neural Interface, 20(4), 340-347.
  • Walczak, J. S., Pichette, V., Leblond, F., Desbiens, K., & Beaulieu, P. (2006). Characterization of chronic constriction of the saphenous nerve, a model of neuropathic pain in mice showing rapid molecular and electrophysiological changes. Journal of Neuroscience Research, 83(7), 1310-1322.
  • Lombard, M. C., & Besson, J. M. (1989). Electrophysiological evidence for a tonic activity of the spinal cord intrinsic opioid systems in a chronic pain model. Brain Research, 477(1-2), 48-56.
  • Kumar, K., Malik, S., & Demeria, D. (2002). Treatment of chronic pain with spinal cord stimulation versus alternative therapies: cost-effectiveness analysis. Neurosurgery, 51(1), 106-116.
  • Hayek, S. M., Veizi, E., & Hanes, M. (2015). Treatment‐limiting complications of percutaneous spinal cord stimulator implants: a review of eight years of experience from an academic center database. Neuromodulation: Technology at the Neural Interface, 18(7), 603-609.
  • Van Buyten, J. P., Wille, F., Smet, I., Wensing, C., Breel, J., Karst, E., ... & Vesper, J. (2017). Therapy‐related explants after spinal cord stimulation: results of an international retrospective chart review study. Neuromodulation: Technology at the Neural Interface, 20(7), 642-649.
  • Negoita, S., Duy, P. Q., Mahajan, U. V., & Anderson, W. S. (2019). Timing and prevalence of revision and removal surgeries after spinal cord stimulator implantation. Journal of Clinical Neuroscience, 62, 80-82.
  • Simopoulos, T., Aner, M., Sharma, S., Ghosh, P., & Gill, J. S. (2019). Explantation of Percutaneous Spinal Cord Stimulator Devices: A Retrospective Descriptive Analysis of a Single-Center 15-Year Experience. Pain Medicine.
  • Prabhala, T., Sabourin, S., DiMarzio, M., Gillogly, M., Prusik, J., & Pilitsis, J. G. (2019). Duloxetine improves spinal cord stimulation outcomes for chronic pain. Neuromodulation: Technology at the Neural Interface, 22(2), 215-218.

Speaker(s):

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