Reoperation Rates and Risk Factors after Spinal Cord Stimulation Revision Surgery.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY Accounts of Chemical Research Pub Date : 2024-10-29 DOI:10.1159/000541445

Samuel H Kim, Christian G Lopez Ramos, Mihir J Palan, Elise Kronquist, Hao Tan, Mohamed Amgad Elsayed Elkholy, Ahmed Raslan

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Abstract

Introduction: Spinal cord stimulation (SCS) is an effective treatment for patients with refractory chronic pain. Despite its efficacy, rates of reoperation after initial implantation of SCS remain high. While revision rates after index SCS surgeries are well reported, less is known about rates and risk factors associated with repeat reoperations. We sought to evaluate patient, clinical, and surgical characteristics associated with repeat reoperation among patients who underwent an initial SCS revision procedure.

Methods: We performed a retrospective review of patients who underwent SCS revision surgery performed at a single institution between 2008 and 2022. Patients were stratified by whether they underwent a single revision (SR) or multiple revision (MR) surgeries. Multivariate logistic regression was performed to determine risk factors associated with repeat SCS revision. Kaplan-Meier survival analysis was used to compare rates of devices requiring revision across groups.

Results: A total of 54 patients underwent an initial SCS revision. Of these, 15 (28%) underwent a second revision. The most common indication for revision surgery was lead migration (65%). No significant differences were observed in age, body mass index, comorbidities, lead type, and revision indication among the SR and MR groups. On multivariate adjusted analysis, only cervical lead position was significantly associated with repeat reoperation (OR 7.10, 95% CI [1.14, 44.3], p = 0.036). Time to reoperation after a single and MR SCS surgeries did not differ.

Conclusions: Among patients who undergo SCS reoperation, a substantial portion requires additional revisions. Cervical lead placement may be associated with a higher risk of repeat revision surgery compared to thoracic lead positioning. Consideration of lead positioning in the decision to perform and undergo reoperation may therefore result in lower revision rates and improved clinical outcomes among SCS patients with MRs.

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脊髓刺激翻修手术后的再手术率和风险因素。

简介脊髓刺激（SCS）是治疗难治性慢性疼痛患者的有效方法。尽管疗效显著，但首次植入 SCS 后的再次手术率仍然很高。尽管对首次 SCS 手术后的翻修率有很多报道，但对与重复再手术相关的比率和风险因素却知之甚少。我们试图评估接受首次 SCS 修正手术的患者中与重复再手术相关的患者、临床和手术特征：我们对 2008 年至 2022 年期间在一家医疗机构接受 SCS 修复手术的患者进行了回顾性研究。根据患者接受的是单次翻修手术（SR）还是多次翻修手术（MR）对患者进行了分层。进行多变量逻辑回归以确定与重复SCS翻修相关的风险因素。采用 Kaplan-Meier 生存分析比较各组需要翻修装置的比率：共有54名患者接受了首次SCS翻修。结果：共有 54 名患者接受了首次 SCS 修复手术，其中 15 人（28%）接受了第二次修复手术。翻修手术最常见的适应症是导联移位（65%）。SR 组和 MR 组在年龄、体重指数、合并症、导联类型和翻修适应症方面均无明显差异。经多变量调整分析，只有颈椎导联位置与再次手术显著相关（OR 7.10，95% CI [1.14，44.3]，P = 0.036）。单次SCS手术和MR SCS手术后再次手术的时间没有差异：结论：在接受SCS再次手术的患者中，有相当一部分需要进行额外的翻修。结论：在接受 SCS 再手术的患者中，有相当一部分需要进行额外的翻修。与胸导联定位相比，颈导联定位可能与更高的重复翻修手术风险相关。因此，在决定是否实施和接受再手术时考虑导联定位可能会降低 MR SCS 患者的翻修率并改善临床疗效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.

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