Risk Factors and Survival Analysis of Spinal Cord Stimulator Explantation

Area of Science:

• Pain Management
• Neurosurgery
• Health Services Research

Background:

• Spinal cord stimulator (SCS) treatment failure, leading to device removal, affects up to 30% of patients.
• Predicting which patients will benefit from SCS is crucial for optimizing treatment outcomes.

Purpose of the Study:

• To identify patient characteristics that predict spinal cord stimulator (SCS) treatment failure.
• To analyze survival and multivariate regression of patients undergoing SCS explantation.

Main Methods:

• Retrospective analysis of 253 patients who underwent SCS placement between 2003-2016 using insurance claims data.
• Inclusion criteria required 6 months of pre- and post-implantation data; explantation defined as removal without replacement within 90 days.
• Patient demographics, opioid use, surgical indications, comorbidities, and reasons for explantation (infectious vs. noninfectious) were analyzed.

Main Results:

• Of 252 eligible patients, 17 (6.7%) underwent SCS explantation (6 infectious, 11 noninfectious).
• Younger age and tobacco use were associated with increased explantation likelihood in bivariate analysis.
• Cox proportional hazards analysis identified younger age, tobacco use, and "other" mental health disorders as predictors of explantation.

Conclusions:

• Noninfectious SCS explantation is more likely in younger patients, tobacco users, and individuals with specific psychiatric conditions.
• Approximately 10% of patients have their SCS devices removed within 5 years.
• Improved prediction of SCS treatment success is necessary for clinical decision-making.