Explantation and Simultaneous Explantation-Reimplantation of Spinal Cord Stimulation Paddle Electrodes: Complication Rate and Predisposing Factors.

Abstract

Background and objectives: Spinal cord stimulation (SCS) is an effective treatment for chronic pain that does not respond to conservative treatment. Nonetheless, up to 38% of all implanted SCS electrodes are explanted, and while the risks involved in the surgical implantation of SCS paddle electrodes are well documented, there is scarce information about SCS explantations and their associated complications. We aimed to document the complication rate and identify their predisposing factors in SCS paddle electrode explantations and simultaneous explantation-reimplantations.

Methods: We retrospectively reviewed the outcomes and the characteristics of all patients who underwent explantation of surgically implanted SCS paddle electrodes at the Helsinki University Hospital Department of Neurosurgery between February 2005 and October 2020.

Results: One hundred thirty-one explantations were performed on 106 patients. The complication rate was 18.3% (24 operations). Major complications occurred during 5 operations (3.8%). No permanent neurological deficits were recorded. Smoking predisposed patients to postoperative complications (P = .023). On average, patients who suffered complications required a day longer hospitalization (2.22 vs 2.92, P = .011). Patients who had repeated explantations (3 or more) suffered significantly more complications than patients who had only 1 or 2 operations (62.5% vs 15.4%, P = .005).

Conclusion: Our results suggest that the explantation of the SCS paddle electrode is a relatively safe surgical procedure. Although severe complications occurred, they were successfully managed. Repeated explantations should be treated cautiously as they seem to increase the complication rate considerably.