Psychologic and Psychiatric Predictors of Spinal Cord Stimulator Explantation and Device Longevity: A Scoping Review

Psychologic and psychiatric factors are clinically plausible contributors to spinal cord stimulation (SCS) discontinuation and device longevity, yet explantation-focused evidence remains fragmented across study designs, outcome definitions, and measurement approaches. This review sought to identify which psychologic and psychiatric factors have been studied in relation to SCS explantation and long-term device retention, and to map how these predictors and outcomes are defined across the literature.

A scoping review was conducted in accordance with Joanna Briggs Institute guidance and reported following Preferred Reporting Items for Systematic reviews and Meta-Analyses-extension for Scoping Reviews. A systematic search was undertaken in MEDLINE (through PubMed), Cochrane Library, and CINAHL, supplemented by reference list screening and targeted Google Scholar searching. Eligible studies included adults (aged ≥18 years) receiving SCS for chronic pain and examined psychologic and psychiatric variables assessed pre- and/or post implantation in relation to explantation or long-term device retention. Data were charted independently by two reviewers. Results were synthesized narratively using descriptive mapping; no formal risk-of-bias appraisal was performed.

The search yielded 589 records; after deduplication (101 removed), 488 records underwent title and abstract screening, nine full texts were assessed, and seven studies were included. Depression and overall psychiatric burden were the most frequently examined predictors, but measurement approaches varied widely and explantation outcomes were defined inconsistently across studies, limiting comparability. Overall, the mapped evidence indicates a mixed yet recurring, noncausal signal between depression-related factors and broader psychiatric comorbidity and earlier or higher explantation, although findings varied by operationalization and were vulnerable to confounding. However, anxiety-specific effects remain unclear and most other constructs show limited or inconsistent associations.

Evidence on psychologic or psychiatric predictors of SCS explantation is limited and methodologically heterogeneous. Future explantation-focused research should harmonize core psychologic constructs, measurement tools, and explant end point definitions, including clearer categorization of explant reasons and standardized longitudinal assessment.