title: Outcomes of percutaneous and paddle lead implantation for spinal cord stimulation: a comparative analysis of complications, reoperation rates, and health-care costs.
abstract: OBJECTIVE
  Spinal cord stimulation (SCS) is a well-established modality for the treatment of chronic pain, and can utilize percutaneous or paddle leads. While percutaneous leads are less invasive, they have been shown to have higher lead migration rates. In this study, we compared the long-term outcomes and health-care costs associated with paddle and percutaneous lead implantation.
  
  
  METHODS
  We utilized the MarketScan data base to examine patients who underwent percutaneous or paddle lead SCS system implantation from 2000 to 2009. Outcomes including complications, reoperation rates, and health-care costs were evaluated in propensity score matched cohorts using univariate and multivariate analyses.
  
  
  RESULTS
  The study cohort was comprised of 13,774 patients. At 90 days following the initial procedure, patients in the SCS paddle group were more likely to develop a postoperative complication than patients receiving percutaneous systems (3.4% vs. 2.2%, p = 0.0005). Two-year (6.3% vs. 3.5%, p = 0.0056) and long-term (five+ years) (22.9% vs. 8.5%, p < 0.0008) reoperation rates were significantly higher in those with percutaneous lead systems. However, long-term health-care costs were similar for those receiving paddle and percutaneous leads ($169,768 vs. $186,139, p = 0.30).
  
  
  CONCLUSIONS
  While the implantation of paddle leads is associated with slightly higher initial postoperative complications, these leads are associated with significantly lower long-term reoperation rates. Nonetheless, long-term health-care costs are similar between paddle and percutaneous leads. Additional improvements in SCS technologies that address the shortcomings of current systems are needed to reduce the risk of reoperation due to hardware failure. Further study is required to evaluate the efficacy of newer percutaneous and paddle SCS systems and examine their comparative outcomes.
authors: Department of Surgery, Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
authors: Ranjith
authors: R
authors: Babu
authors: Matthew A
authors: MA
authors: Hazzard
authors: Kevin T
authors: KT
authors: Huang
authors: Beatrice
authors: B
authors: Ugiliweneza
authors: Chirag G
authors: CG
authors: Patil
authors: Maxwell
authors: M
authors: Boakye
authors: Shivanand P
authors: SP
authors: Lad
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016208:Databases, Factual; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D004567:Electrodes, Implanted; D004824:Epidural Space / Q000502:physiology / Q000601:surgery; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000601:surgery*; D012086:Reoperation / Q000191:economics* / Q000706:statistics & numerical data; D013116:Spinal Cord / Q000502:physiology / Q000601:surgery; D013119:Spinal Cord Injuries / Q000628:therapy*; D062187:Spinal Cord Stimulation / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: Health-care cost; paddle lead; percutaneous lead; reoperation; spinal cord stimulation