Pain Outcomes after Spinal Cord Stimulator Revision Surgery

Introduction: Spinal Cord Stimulation (SCS) is a proven treatment for several etiologies of pain, but optimal results are not always achieved with the initial placement surgery. When the desired effects are not met, surgical replacement of the lead may be required. However, stimulator revision can carry added surgical risks and therapeutic improvement is not always guaranteed. This study investigates the clinical outcomes of SCS lead replacement and examines the benefits and risks of repeat procedures.

Methods: A retrospective chart review of patients who had SCS revision surgeries at Michigan Medicine was conducted. Changes in pain ratings and Medication Quantification Scale (MQS) scores from pre-op to follow-up were used to evaluate revision success. Analysis was performed using Python. HUM00252047

Results: A total of 89 patients (60 female, age 46 ± 14) underwent SCS revision with initial placements in the cervical (n=18), thoracic (n=66), lumbar (n=1), and sacral (n=4) regions. Revision reasons included inadequate coverage, hardware issues, cord compression, infection, lead migration, hematoma, impedance, and IPG site pain. Pain score changes varied by surgery: initial surgery mean ΔP was 2.74 ± 3.08 (p=2.6e-05), first revision -1.36 ± 2.65 (p=0.08), and second revision -2.4 ± 3.21 (p=0.17). Changes in MQS also varied: initial surgery mean ΔMQS was –0.31 ± 27.01 (p=0.95), first revision –3.15 ± 19.50 (p=0.15), second revision 11.95 ± 20.65 (p=0.01), and third revision –9.67 ± 17.80 (p=0.28).

Conclusion : Preliminary analysis indicates that SCS can still provide pain relief after multiple revisions. The first and second revision surgeries showed a greater reduction in post-op pain scores compared to index, which demonstrated a mean increase in pain following SCS placement. Third revisions had a greater impact on reducing MQS scores compared to the index surgery and first revisions. Further analysis with larger samples is needed to better assess the benefits and risks of SCS revision surgery.