title: Treatment-Limiting Complications of Percutaneous Spinal Cord Stimulator Implants: A Review of Eight Years of Experience From an Academic Center Database.
abstract: OBJECTIVE
  The study aims to evaluate the long-term implant survival and complications of spinal cord stimulation (SCS) leading to surgical revision or explant in patients treated for chronic noncancer pain.
  
  
  METHODS
  This is a retrospective study of all patients who underwent a percutaneous spinal cord stimulation trial followed by implant in an academic Pain Medicine division by four practitioners from 2007 to 2013, with follow-up data through April 2014.
  
  
  RESULTS
  A total of 345 patients were considered candidates for dorsal column stimulation and underwent a trial. Two hundred thirty-four patients were implanted with an implant-to-trial ratio of 67-86% across various chronic pain entities (postlaminectomy syndrome, complex regional pain syndrome, small-fiber peripheral neuropathy, abdominal/pelvic pain, nonsurgical candidates with lumbosacral neuropathy, and neuropathic pain not otherwise specified), with the exception of nonsurgical candidates with lumbosacral neuropathy who had an implant ratio of 43%. The complication rate was 34.6%, with the hardware related being the most common reason, comprising 74.1% of all complications. The revision and explant rates were 23.9% each. The most common reason for explant was loss of therapeutic effect (41.1%).
  
  
  CONCLUSIONS
  SCS is an effective treatment for chronic noncancer pain. It is a minimally invasive procedure, safe, and with good long-term outcomes. However, the surgical revision and explant rates are relatively high. As the use of SCS continues to grow, research into the causes of and risk factors for SCS-related complications is paramount to decrease complication rates in the future.
authors.affiliation: Department of Anesthesiology, Division of Pain Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA.|Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Salim M
authors.initials: SM
authors.lastname: Hayek
authors.affiliation: Case Western Reserve University, Cleveland, OH, USA.|Pain Medicine and Spine Care, Louis Stokes Veterans Administration Medical Center, Cleveland, OH, USA.
authors.forename: Elias
authors.initials: E
authors.lastname: Veizi
authors.affiliation: Department of Anesthesiology, Division of Pain Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Hanes
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000628:therapy*; D016208:Databases, Factual / Q000706:statistics & numerical data; D004567:Electrodes, Implanted / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D062187:Spinal Cord Stimulation / Q000379:methods*; D016896:Treatment Outcome
keywords: Complications; neuropathic pain; outcomes; retrospective study; spinal cord stimulation