Risk Factors for Spinal Cord Stimulator Explant After Implantation for Neuropathic Pain: A Systematic Review

Area of Science:

• Neurology
• Pain Management
• Biomedical Engineering

Background:

• Spinal cord stimulation (SCS) is a recognized treatment for neuropathic pain.
• Device explant can lead to treatment failure in SCS therapy.
• Identifying explant risk factors is crucial for optimizing SCS patient outcomes.

Purpose of the Study:

• To systematically review and identify risk factors associated with spinal cord stimulation device explant.
• To inform strategies for improving patient selection and management in SCS therapy.

Main Methods:

• A comprehensive systematic literature search was conducted across multiple databases (PubMed, Embase, CINAHL, Scopus, Web of Science, Cochrane).
• Inclusion criteria focused on adult patients with SCS for neuropathic pain who subsequently had their device explanted.
• Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale.

Main Results:

• Twenty-one studies were included, identifying risk factors across device (e.g., older models, percutaneous electrodes), patient (e.g., age, mental health, comorbidities, opioid use), and disease indication categories.
• Infection was also noted as a risk factor.
• Meta-analysis was precluded by heterogeneity in study definitions and analyses.

Conclusions:

• Several device, patient, and disease-related factors contribute to spinal cord stimulation explant risk.
• Further investigation into these factors is essential for enhancing SCS patient selection, implantation procedures, and overall treatment efficacy.
• Improved understanding can lead to better chronic pain management outcomes.