Spinal cord stimulation for chronic pain: a retrospective cohort study of patients from a Canadian tertiary centre.

Abstract

Purpose: Spinal cord stimulation (SCS) is a surgical intervention for patients with neuropathic pain refractory to medical management. There are limited data on its outcomes from Canadian centres. We aimed to describe the indications, patient- and procedure-related characteristics, and outcomes of patients who underwent SCS implantation at a Canadian tertiary centre.

Methods: We conducted a retrospective cohort study of patients who underwent SCS at St. Michael's Hospital (Toronto, ON, Canada) between 1 January 2020 and 31 July 2023. We collected data on patient demographics, analgesic use, type of SCS trial (percutaneous vs tunneled), indication, antibiotic use during and after surgery, and complications.

Results: We included 100 patients with a mean (standard deviation) age of 62 (14) yr. Indications included chronic pain after spinal surgery (n = 44), chronic back pain (no prior spine surgery) (n = 22), complex regional pain syndrome (n = 6), spinal stenosis (n = 4), and visceral pain (n = 4). Complications included implantable pulse generator-associated pain (47%), lead migration (14%), lead fracture (9%), surgical site infection (2%), and cerebrospinal fluid leak (6%). Almost all patients were on pharmacotherapy for pain relief at baseline (n = 96) and agents included opioids, nonsteroidal anti-inflammatory drugs, anticonvulsants, and antidepressants.

Conclusions: In this cohort of patients who underwent SCS implantation at a Canadian tertiary centre, infection and lead migration rates were consistent with global estimates (3.8% and up to 27%, respectively); nevertheless, we observed high rates of dural puncture compared with an expected incidence of 0.48%.