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In this retrospective study of patients who underwent reoperation for removal of an implanted SCS system, we aim to shed light on potential avenues to reduce morbidity and improve patient outcomes.
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Although reported complication rates range widely, from 20% to 40%, 8, 17 to date there is little evidence about which complications result in revision or total removal of the implanted stimulation system. 2 Like many chronically implanted devices, complications associated with spinal cord stimulator (SCS) placement and utilization are increasingly studied with the hopes of improving surgical technique and addressing the mechanical limitations that lead to hardware failure. 23 The treatment is used most often to address neuropathic pain from failed–back surgery syndrome (FBSS) and complex regional pain syndrome (CRPS), and also has reported applications in postherpetic neuralgias and other dysesthesias. 8 Given its fairly consistent results in this extremely complex patient population, the application of spinal cord stimulation has rapidly expanded since its first use in 1967. 22 It has been shown to improve pain relief, reduce narcotic analgesic use, and promote independence in patients with refractory pain syndromes. The 72 patients who underwent formal psychiatric evaluation before implantation were affected by high rates of major depression (64%), anxiety (34%), posttraumatic stress disorder (PTSD) (12%), drug or alcohol abuse (12%), and physical or sexual abuse (22%).Į pidural spinal cord stimulation is a well-established treatment modality developed to assist in the management of various medically and surgically refractory neuropathic pain syndromes. Primary reasons for hardware removal were lack of stimulation efficacy (81%), electrode failure due to migration (14%), and allergic reactions to implanted hardware in 2 patients. Among 15 patients with acute postsurgical complications (12 infections, 2 hemorrhages, 1 immediate paraplegia), the median time to removal was 2 months. Initial postoperative reduction in pain was reported in 81% of patients, and 37.8% returned to work. More than half of patients were legally disabled. Thoracic or upper lumbar leads were placed in 89.9% of patients primarily for the diagnosis of postsurgical failed–back surgery syndrome (70.5%), chronic regional pain syndrome (14.7%), and neuropathic pain (8.5%). The 74 (57%) women and 55 (43%) men were a median of 49 years old (IQR 41–61 years) at explantation the median time to explantation was 20 months (IQR 7.5–45.5 months).