Spinal Cord Stimulation via Percutaneous and Open Implantation: Systematic Review and Meta-Analysis Examining Complication Rates

Amy Z Blackburn; Hunter H Chang; Kevin DiSilvestro; Ashwin Veeramani; Christopher McDonald; Andrew S Zhang; Alan Daniels

doi:10.1016/j.wneu.2021.07.077

Spinal Cord Stimulation via Percutaneous and Open Implantation: Systematic Review and Meta-Analysis Examining Complication Rates

World Neurosurg. 2021 Oct:154:132-143.e1. doi: 10.1016/j.wneu.2021.07.077. Epub 2021 Jul 31.

Authors

Amy Z Blackburn¹, Hunter H Chang², Kevin DiSilvestro³, Ashwin Veeramani⁴, Christopher McDonald³, Andrew S Zhang³, Alan Daniels⁵

Affiliations

¹ Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
² Department of Mathematics, Northwestern University, Evanston, Illinois, USA.
³ Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University/University Orthopedics, Providence, Rhode Island, USA.
⁴ Division of Applied Mathematics, Brown University, Providence, Rhode Island, USA.
⁵ Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University/University Orthopedics, Providence, Rhode Island, USA. Electronic address: alandanielsmd@gmail.com.

PMID: 34343680
DOI: 10.1016/j.wneu.2021.07.077

Abstract

Background: Spinal cord stimulation (SCS) has become a successful therapeutic option for combating chronic pain and can be implanted via percutaneous or open (laminotomy/laminectomy) techniques. This study aimed to systematically review the complications that occur after SCS placement via percutaneous and open (laminotomy/laminectomy) in failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS), and chronic back (lumbosacral)/leg pain.

Methods: The PubMed and Embase databases were searched from inception to June 2020; prospective studies using SCS in patients with FBSS, CRPS, and chronic low back pain that reported both complications and the implantation method used were included. Effects and results from each study were combined using a random-effects model and were structured for subgroup analysis between open implantation and percutaneous implantation. Meta-regression was performed by calculating a mean difference and weighted by inverse variance and 95% confidence intervals (CIs).

Results: Thirty-two articles were included in this systematic review and meta-analysis. Using several different patient- and event-based metrics, our meta-analysis revealed an overall average complication rate of 21.1% (95% CI, 14.9-27.2). Equipment, technical, and medical complications occurred at rates of 12.1%, 1.1%, and 6.3%, respectively. Lead migration and infection rates were 5.6% and 3.8%, respectively. When comparing the 2 implant techniques, medical-related surgical reinterventions and explants due to infection were more common in open compared with percutaneous SCS procedures.

Conclusions: Equipment-related complications accounted for the majority of SCS complications. Percutaneous SCS resulted in less reintervention and fewer explants caused by medical-related complications and infection, respectively. These conclusions may provide a general understanding of the SCS complications profile for physicians who care for SCS patients.

Keywords: Chronic pain; Complex regional pain syndrome; Complications; Failed back surgery syndrome; Meta-analysis; Spinal cord stimulation; Systematic review.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Back Pain / surgery
Electrodes, Implanted*
Humans
Minimally Invasive Surgical Procedures / methods*
Neurosurgical Procedures / methods*
Spinal Cord Stimulation / methods*