title: Rate of perioperative neurological complications after surgery for cervical spinal cord stimulation.
abstract: OBJECTIVE Cervical spinal cord stimulation (cSCS) is used to treat pain of the cervical region and upper extremities. Case reports and small series have shown a relatively low risk of complication after cSCS, with only a single reported case of perioperative spinal cord injury in the literature. Catastrophic cSCS-associated spinal cord injury remains a concern as a result of underreporting. To aid in preoperative counseling, it is necessary to establish a minimum rate of spinal cord injury and surgical complication following cSCS. METHODS The Nationwide Inpatient Sample (NIS) is a stratified sample of 20% of all patient discharges from nonfederal hospitals in the United States. The authors identified discharges with a primary procedure code for spinal cord stimulation (ICD-9 03.93) associated with a primary diagnosis of cervical pathology from 2002 to 2011. They then analyzed short-term safety outcomes including the presence of spinal cord injury and neurological, medical, and general perioperative complications and compared outcomes using univariate analysis. RESULTS Between 2002 and 2011, there were 2053 discharges for cSCS. The spinal cord injury rate was 0.5%. The rates of any neurological, medical, and general perioperative complications were 1.1%, 1.4%, and 11.7%, respectively. There were no deaths. CONCLUSIONS In the largest series of cSCS, the risk of spinal cord injury was higher than previously reported (0.5%). Nonetheless, this procedure remains relatively safe, and physicians may use these data to corroborate the safety of cSCS in an appropriately selected patient population. This may become a key treatment option in an increasingly opioid-dependent, aging population.
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, California.
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Chan
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, California.
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Winkler
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, California.
authors.forename: Line
authors.initials: L
authors.lastname: Jacques
mesh_terms: D066193:Cervical Cord / Q000601:surgery*; D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D010146:Pain / Q000453:epidemiology; D059408:Pain Management / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology*; D013119:Spinal Cord Injuries / Q000453:epidemiology / Q000209:etiology; D062187:Spinal Cord Stimulation / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: DVT = deep venous thrombosis; HCUP = Healthcare Cost and Utilization Project; ICD-9 = International Classification of Diseases; LOS = length of stay; NIS = Nationwide Inpatient Sample; Ninth Revision; PE = pulmonary embolism; SCS; cSCS = cervical spinal cord stimulation; cervical spinal cord stimulation; neuromodulation; neurostimulation