title: Incidence of Revision Surgery in a Large Cohort of Patients With Thoracic Surgical Three-Column Paddle Leads: A Retrospective Case Review.
abstract: OBJECTIVE
  Spinal cord stimulation (SCS) revision surgery remains common, with a negative impact on cost-effectiveness and outcomes. The primary goal in this report was to retrospectively study the need for revision surgery in a large cohort of patients with newly implanted thoracic surgical three-column paddle leads, focusing on a method of implantation to reduce the need for revision surgery. Clinical outcomes were also assessed.
  
  
  METHODS
  The outcomes in 126 patients who received initial surgical paddle SCS implants for back and/or leg pain from 2008 to 2012 were retrospectively analyzed. A disinterested third party performed chart reviews and telephone interviews. A single surgeon with a consistent method performed all implants, with no lead anchoring. All three major commercial vendors were utilized.
  
  
  RESULTS
  There were no paddle electrode lead revisions required for spontaneous fracture, migration, or infection at an average chart-review follow-up period of 20 months. With subsequent telephone interviews, a 65% clinical success rate was seen at 29 months. Significant suboptimal stimulation with body-position changes (SSBPC) was reported in less than 10% of patients. All results were vendor-independent.
  
  
  CONCLUSIONS
  This report, the largest to date on patients with three-column paddle leads, shows low electrode revision rates with expected clinical success rates. Clinically relevant SSBPC was uncommon.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Pahapill
mesh_terms: D000293:Adolescent; D015331:Cohort Studies; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D015994:Incidence; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010147:Pain Measurement; D062187:Spinal Cord Stimulation / Q000295:instrumentation* / Q000379:methods*; D016896:Treatment Outcome
keywords: Case series; complications; electrode paddle; nonanchoring; retrospective study; spinal cord stimulation