The impact of prior back surgery on neuromodulation outcomes: A review of over 500 patients.
OBJECTIVE
To evaluate neuromodulation outcomes in patients with prior back surgery.


METHODS
Adults in our prospective observational sacral/pudendal neuromodulation study were retrospectively evaluated. History and operative details were reviewed, and outcomes were measured at 3, 6, 12, and 24 months with overactive bladder questionnaire (OAB q) symptom severity (SS)/health related quality of life (HRQOL), interstitial cystitis symptom/problem indices (ICSI - PI), voiding diaries, and global response assessments (GRA). Data were examined with Pearson's χ2, Fisher's exact, Wilcoxon rank sum tests, and logistic regression multivariate analysis.


RESULTS
Five hundred and sixty patients were evaluated (mean age 58.8 ± 17 years; 83% female; 79% had a sacral lead placed), 109 (19%) had history of back surgery; 66 surgeries were lumbar. Back surgery patients were older (mean 63 ± 15 vs. 58 ± 17 years; P = 0.003) and a higher proportion had urge urinary incontinence (UUI) (64% vs. 50% P = 0.008). Generator implant rates were similar (94% vs. 91%; P = 0.34). OABq-SS and HRQOL and ICSI - PI composite scores did not differ between groups at any time point. On bladder diaries, median incontinence episodes daily at baseline and between stages were worse in the prior back surgery group but all bladder diary parameters improved significantly in both groups with the exception of mean voided volume which only improved significantly in the non-back surgery group. Most patients in both groups reported moderate/marked improvement in overall bladder symptoms.


CONCLUSIONS
This study suggests that prior back surgery does not appear to impact clinical outcomes; therefore, neuromodulation may be offered in this patient population.
Beaumont Health System, Royal Oak, Michigan.|Oakland University William Beaumont School of Medicine, Rochester, Michigan.
Jamie M
JM
Bartley
Beaumont Health System, Royal Oak, Michigan.
Kim A
KA
Killinger
Beaumont Health System, Royal Oak, Michigan.|Oakland University William Beaumont School of Medicine, Rochester, Michigan.
Judith A
JA
Boura
Beaumont Health System, Royal Oak, Michigan.
Priyanka
P
Gupta
Beaumont Health System, Royal Oak, Michigan.
Natalie
N
Gaines
Beaumont Health System, Royal Oak, Michigan.|Oakland University William Beaumont School of Medicine, Rochester, Michigan.
Jason P
JP
Gilleran
Beaumont Health System, Royal Oak, Michigan.|Oakland University William Beaumont School of Medicine, Rochester, Michigan.
Kenneth M
KM
Peters
D000328:Adult; D000368:Aged; D004599:Electric Stimulation Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000628:therapy*; D014549:Urinary Incontinence / Q000628:therapy*
bladder; neuromodulation; outcome studies; overactive; spinal nerve roots