Spinal cord stimulator utilization trends and predictors of unsuccessful trial-to-implant conversion

Abstract

Background

Spinal cord stimulators (SCS) are neuromodulatory devices that may be considered for refractory back or neurologic pain. Trends in SCS utilization and factors associated with failure of trial-to-implant conversion are not well defined.

Methods

Using the 2010 - 2022 PearlDiver Mariner Patient Claims Database, adults who underwent SCS trial were identified and categorized into those who did or did not undergo conversion to permanent SCS implantation. Multivariable logistic regression was used to identify clinical (age, sex, Elixhauser Comorbidity Index, and tobacco use) and non-clinical (insurance plan and US geographic region) characteristics associated with lower odds of trial-to-implant conversion.

The annual incidences of SCS utilization, trial-to-implant conversion, and breakdown of specialties performing SCS implantation (pain specialists, neurosurgeons, orthopedic surgeons) were analyzed.

Results

Of 265,756 patients undergoing SCS trial, 178,144 (67%) went on to receive permanent implant while 87,612 (33%) did not. Factors independently associated with lower odds of successful trial-to-implant conversion included: older age (OR: 0.97 per decade increase), male sex (OR: 0.93, relative to female), lower comorbidity burden (OR: 0.96 per 1-point ECI decrease), no documented tobacco use (OR: 0.94), insurance (relative to Commercial, Medicaid [OR: 0.78] and Medicare [OR: 0.85]) and geographic region (relative to Midwest, Northeast [OR: 0.63], West [OR: 0.82], and South [OR: 0.85]) (P < 0.05 for all).

The incidence of SCS trialing increased over the years from 17.9 to 22.9 patients per 100,000 covered lives in the database (P < 0.05). The rate of successful trial-to-implant conversion increased from 63.4% in 2010 to 73.3% in 2021 (P < 0.05). The breakdown of physician specialties implanting SCS remained similar over the years.

Conclusions

The overall utilization of SCS and trial-to-implant conversion rates have increased over the years. By defining clinical and nonclinical factors associated with failure for conversion from trial to implant, selection processes can be further optimized by specialists performing these procedures.