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Permanent trials for spinal cord stimulation.

Sruti Bandlamuri1, Tessa A Harland1, Julie G Pilitsis2

  • 1Department of Neurosurgery, Albany Medical College, Albany, New York, USA.

Pain Practice : the Official Journal of World Institute of Pain
|February 7, 2025
PubMed
Summary
This summary is machine-generated.

Spinal cord stimulator (SCS) permanent trials offer a viable alternative for patients unsuitable for traditional screening. This method shows a high conversion rate to permanent implant with comparable complication rates, proving effective for high-risk individuals.

Keywords:
anticoagulantsback painchronic paindorsal root ganglionnerve painneuromodulationneuropathic painneurosurgical proceduresoperativerefractory painspinal cord stimulationspinal cord stimulation trialsurgical procedures

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Area of Science:

  • Neurosurgery
  • Pain Management
  • Medical Devices

Background:

  • Spinal cord stimulator (SCS) screening trials typically use percutaneous leads.
  • Patients unsuitable for screening trials may undergo a
  • permanent trial
  • with tunneled leads for potential conversion to a permanent system.
  • Limited literature exists on the outcomes of this permanent trial methodology.

Purpose of the Study:

  • To evaluate the clinical outcomes and feasibility of the permanent trial methodology for SCS implantation.
  • To assess the trial-to-implant conversion rate, patient response, and complication profile in patients undergoing permanent trials.

Main Methods:

  • Retrospective review of 27 patients who underwent permanent SCS trials between 2014 and 2020 at a single institution.
  • Data collected included demographics, pain scores (NRS), follow-up duration, revisions, complications, and removals.

Main Results:

  • Out of 762 SCS placements, 27 (3.54%) underwent permanent trials (7 paddle, 14 percutaneous, 6 DRG).
  • Reasons for permanent trials included failed percutaneous trials, anticoagulation issues, prior thoracic surgery, and medical comorbidities.
  • 88.8% proceeded to permanent implant, with 66.7% achieving >50% pain reduction at 3 months.
  • Complications included lead issues and CSF leak; revision surgery was needed for 3 patients.

Conclusions:

  • Permanent SCS trials demonstrate a higher trial-to-implant conversion rate than traditional percutaneous trials.
  • This technique is a valuable option for high-risk patients unsuitable for standard screening.
  • Rates of revisions and complications are comparable to traditional methods, supporting its role in patient selection.