Artikel
Spinal cord stimulation: Complications requiring re-operations
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Autoren
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Kathrin Steib
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg, Regensburg
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Alexander Brawanski
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg, Regensburg
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Jürgen Schlaier
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg, Regensburg
| Veröffentlicht: | 13. Mai 2014 |
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Gliederung
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Objective: Spinal Cord Stimulation (SCS) is a well established procedure for the treatment of different chronic pain syndromes. The aim of our study was to evaluate complications requiring re-operations.
Method: 84 patients (37 female, 47 male) with a mean age of 48.8 years treated with SCS were included in our retrospective analysis. Indications for SCS implantation were chronic neuropathic pain, failed back surgery syndrome, CRPS, peripheral arterial occlusive disease and phantom pain. Based on patient charts we analyzed age, gender, diagnosis, revision rates and indications for re-operation.
Results: After a trial period the complete SCS system was implanted in 69 out of 84 patients. Reasons for not implanting a permanent system were minimal alleviation of pain (n=9), aggravation of pain (n=2) and in 4 patients the lead couldn’t be placed properly.12 permanent SCS systems were explanted: 10 of which because the effect on pain alleviation has been wearing off, 1 due to infection, 1 because of material incompatibility. 4 patients who had their SCS system explanted had a pronounced psychological comorbidity. 25 of the 69 permanently implanted patients have an on-going good response and no re-operation was necessary (36.2%). In 44 patients a total number of 62 re-operations were performed. 21 of those patients underwent one revision (30.4%), 13 patients had two (18.8%), 8 patients three revisions (11.6%) and 2 patients had six re-operations (2.9%). Re-operations included exchanges of broken leads or extensions (n=18), exchange of 4-contact for 8-contact leads due to insufficient covering of the pain area (n=4), exchange of percutaneous for paddle leads because of unpleasant changes in stimulation intensity (n=16), repositioning of the lead (n=15), revision of paddle leads (n=6), re-implantation after explantation (n=1; infection), revision of the generator pocket because of local discomfort (n=3).
Conclusions: Complications requiring re-operations are mainly caused by lead exchanges due to breakage, lead positioning effects on insufficient coverage of the painful area or unpleasant changes in stimulation intensity.
