Desórdenes neurológicos

Evaluation of Pre-operational Factors Contributing to a Dorsal Column Stimulator Explantation

Abstract

Maximilian A. Kinne1*, R. Scott Cowan2 and Alexander Knee3

Objectives: Implantation of a dorsal column stimulator (DCS) for axial spine and radicular pain is a commonly performed procedure. Despite the benefits of this device to reduce pain and improve quality of life, some patients elect to have the device explanted. The purpose of this study is to describe pre-operational factors among patients who elected to have their DCS explanted and how these factors are associated with reason for explantation.

Materials and methods: We conducted a retrospective descriptive study using the database of a private outpatient orthopedic clinic. We included all patients who had a DCS explanted between January 1, 2007 and June 19, 2014. Data was collected on patient demographics, past medical and back surgery history, as well as details of implantation, permanent device implantation, and subsequent explantation. Reasons for explantation were categorized as: inadequate pain control using three categories (with no device related pain/discomfort, with device related pain/discomfort, or inadequate pain control and patient wants MRI), or pain resolved.

Results: A consecutive sample of 100 subjects who underwent explantation of a DCS was identified for review. Of these 100 subjects, 14 were excluded. Based on our data, we hypothesize that sex (57% female, 43% male) degenerative disc disease (72%), previous back surgery (70%), BMI classified as overweight (subject average=28.3), history of tobacco usage (57%), and history of narcotic use (80%) may be potential risk factors for explantation.

Conclusion: With respect to clinical evaluation of patients as candidates for spinal cord stimulator implantation, we cannot recommend that any of the evaluated variables be considered a contraindication to proceeding with a trial procedure. Future studies are planned to compare these data to a control group of subjects to establish risk factors predisposing individuals to explantation of a DCS.