Factors Associated with Long-Term Spinal Cord Stimulator Efficacy: An Analysis of the TriNetX Multinational Database

Introduction: Spinal cord stimulation (SCS) is used to treat chronic pain in the neurosurgical patient population. Long-term outcome and comparison between open and percutaneous SCS systems on a global level, and in particular long-term data regarding device abandonment, are poorly described in the literature.

Methods: The TriNetX multinational database was queried from 2013-2023 using CPT and ICD-10 codes. Propensity-score matching was performed between percutaneous (pSCS) and open (oSCS) cohorts and outcomes compared. As the documented median IPG lifespan is approximately 9 years, a sub-cohort of “early implants” (years 2013-2015) was created to determine presumed device abandonment (PDA). PDA rate was defined as the number of surviving SCS implants who did not undergo IPG replacement within the duration of our study. Chi-square, t-test, and logistic regression analyses were performed.

Results: TriNetX identified 20,373 SCS implants (n=11,007 oSCS; n=9,366 pSCS), of which 2,154 (11.3%) were explanted. pSCS had slightly higher rates of explant compared to oSCS (11.6% vs 10.5%, p=0.036). pSCS and oSCS had similar rates of revision (4.9% vs 4.5%, p=0.25), mechanical complication (13.6% vs 13.9%, p=0.61) and infection (1.48% vs 1.46%, p=0.91). SCS explant was associated with younger age (OR 0.985 [0.982-0.987], p< 0.001), female sex (OR 1.323 [1.223-1.432], p< 0.001), post-laminectomy syndrome (OR 1.219 [1.12-1.327], p< 0.001), opioid use disorder (OR 1.289 [1.112-1.494], p=0.001), dorsalgia (OR 1.222 [1.069-1.398, p=0.003), and mood/affective disorders (OR 1.157 [1.051-1.273], p=0.003). Of the 1,328 surviving early implants, 321 (24.2%) underwent IPG replacement. IPG replacement was positively associated with preoperative psychiatric evaluation (OR 1.519, p=0.043) and white race (OR 1.477, p=0.021), and negatively associated with fibromyalgia (OR 0.648, p=0.039) and nicotine dependence (OR 0.632, p=0.028).

Conclusion : Our study suggests a 75.8% PDA rate among surviving, early SCS implants. Lack of preoperative psychiatric evaluation, comorbid fibromyalgia or nicotine use, and non-White race may increase likelihood of SCS abandonment.