title: Long-term outcomes after replacement of percutaneous leads with paddle leads in a retrospective cohort of patients with spinal cord stimulation systems.
abstract: BACKGROUND
  Although the long-term outcomes for spinal cord stimulation (SCS) have been reported, long-term outcomes of patients who underwent revisions of the SCS with paddle leads are lacking.
  
  
  OBJECTIVE
  To report the long-term outcomes of 39 patients who had percutaneous SCS revised with a new paddle lead.
  
  
  METHODS
  Baseline and follow-up mail-in questionnaires assessed pain and disability levels with numerical rating scales, somatotopical overlap between SCS-related paresthesias and areas of chronic pain, and overall satisfaction. Analysis was performed with regard to age, sex, diagnosis, duration of disease, number of surgical revisions, complications, and interval between surgeries.
  
  
  RESULTS
  After surgical revision, 20 patients (50%) had at least a 3-point reduction in the numerical rating scale. Greater pain reduction was correlated with better coverage (P = .001). Coverage area was greater in patients with a single revision than in patients with multiple revisions (P = .01). Good satisfaction was reported by 25 patients (62.5%) who indicated that they would undergo the procedure again in order to achieve the same results. These patients had significantly greater pain reduction (P = .001) and better coverage (P = .002) than patients who reported otherwise. No other major complication occurred.
  
  
  CONCLUSIONS
  Revision of percutaneous SCS systems with implantation of a new paddle lead is safe and more effective in patients who have undergone not more than 1 prior revision.
authors.affiliation: Center for Neurological Restoration, Cleveland Clinic Neurological Institute, Cleveland, Ohio.
authors.forename: Caio M
authors.initials: CM
authors.lastname: Matias
authors.forename: Amit
authors.initials: A
authors.lastname: Amit
authors.forename: Scott F
authors.initials: SF
authors.lastname: Lempka
authors.forename: John G
authors.initials: JG
authors.lastname: Ozinga
authors.forename: Sean J
authors.initials: SJ
authors.lastname: Nagel
authors.forename: Darlene A
authors.initials: DA
authors.lastname: Lobel
authors.forename: Andre G
authors.initials: AG
authors.lastname: Machado
mesh_terms: D000368:Aged; D059350:Chronic Pain / Q000628:therapy*; D020878:Device Removal / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D012086:Reoperation; D012189:Retrospective Studies; D062187:Spinal Cord Stimulation / Q000295:instrumentation*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome