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

Spinal cord stimulation (SCS) is a safe and effective modality for management of neuropathic pain; however, it can lead to loss of therapy and subsequent device explant in some patients. This systematic review aims to identify risk factors for device explant.

A comprehensive search of the data bases (MEDLINE through PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature [CINAHL], Scopus, Web of Science, and Cochrane Database of Systematic Reviews) was performed from Jan 1, 2003 to Dec 31, 2024. The inclusion criteria were English full-text articles in patients aged ≥18 years with SCS implanted for primary neuropathic condition and subsequently explanted after any period, which studied ≥one risk factor for explant. Two reviewers independently screened articles for inclusion and extracted data. The Newcastle-Ottawa Quality Assessment Scale was used to assess risk of bias. Data on risk factors were categorized and described, with meta-analysis using random effects if amenable.

The data base search identified 682 unique studies, of which 21 were included. The risk factors identified for SCS device explant were categorized into device (n = 6 studies: eg, older devices, conventional rechargeable devices, percutaneous electrodes), patient (18 studies: eg, age, sex, mental health, other comorbidities, chronic perioperative opioid use, and preoperative diazepam use), and disease indications (three studies: eg, complex regional pain syndrome, persistent spinal pain syndromes, and chronic pain of surgical origin) and other (eg, two studies: eg, infection). Meta-analysis was not possible owing to heterogeneity in variable definition and analyses among included studies.

This systematic review identified various risk factors for device explant in adult patients receiving SCS for primary neuropathic pain. These factors require further studies to improve patient selection, insertion, and management of SCS devices and chronic pain outcomes.