title: The Incidence of Spinal Cord Injury in Implantation of Percutaneous and Paddle Electrodes for Spinal Cord Stimulation.
abstract: OBJECTIVE
  Spinal cord stimulation (SCS) has been proven effective for multiple chronic pain syndromes. Over the past 40 years of use, the complication rates of SCS have been well defined in the literature; however, the incidence of one of the most devastating complications, spinal cord injury (SCI), remains largely unknown. The goal of the study was to quantify the incidence of SCI in both percutaneous and paddle electrode implantation.
  
  
  METHODS
  We conducted a retrospective review of the Thomson Reuter's MarketScan database of all patients that underwent percutaneous or paddle SCS implantation from 2000 to 2009. The main outcome measures of the study were the incidence of SCI and spinal hematoma within 30 days following operation.
  
  
  RESULTS
  Overall 8326 patients met inclusion criteria for the study (percutaneous: 5458 vs. paddle: 2868). The overall incidence of SCI was 177 (2.13%) (percutaneous: 128 (2.35%) vs. paddle: 49 (1.71%), p = 0.0556). The overall incidence of spinal hematoma was 59 (0.71%) (percutaneous: 41 (0.75%) vs. paddle: 18 (0.63%), p = 0.5230).
  
  
  CONCLUSIONS
  Our study shows that the overall incidence of SCI in SCS is low (2.13%), supporting that SCS is a safe procedure. No significant difference was found in the rates of SCI or spinal hematoma between the percutaneous and paddle groups. Further studies are needed to characterize the mechanisms of SCI in SCS and long-term outcomes in these patients.
authors.affiliation: School of Medicine, Duke University, Durham, NC, USA.
authors.forename: Frank W
authors.identifier: http://orcid.org/0000-0003-2689-1561
authors.initials: FW
authors.lastname: Petraglia
authors.affiliation: School of Medicine, Duke University, Durham, NC, USA.
authors.forename: S Harrison
authors.identifier: http://orcid.org/0000-0002-0171-6516
authors.initials: SH
authors.lastname: Farber
authors.affiliation: School of Medicine, Duke University, Durham, NC, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Gramer
authors.affiliation: School of Medicine, Duke University, Durham, NC, USA.
authors.forename: Terence
authors.initials: T
authors.lastname: Verla
authors.affiliation: Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
authors.forename: Frances
authors.initials: F
authors.lastname: Wang
authors.affiliation: Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Thomas
authors.affiliation: Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Beth
authors.initials: B
authors.lastname: Parente
authors.affiliation: Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Shivanand P
authors.initials: SP
authors.lastname: Lad
mesh_terms: D000328:Adult; D000368:Aged; D001416:Back Pain / Q000628:therapy; D015331:Cohort Studies; D016208:Databases, Factual / Q000706:statistics & numerical data; D004567:Electrodes, Implanted / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011183:Postoperative Complications / Q000453:epidemiology*; D013119:Spinal Cord Injuries / Q000453:epidemiology* / Q000209:etiology*; D062187:Spinal Cord Stimulation / Q000009:adverse effects* / Q000295:instrumentation; D016896:Treatment Outcome
keywords: Complications; SCS; spinal cord injury; spinal cord stimulation; spinal hematoma