The Incidence of Spinal Cord Injury in Implantation of Percutaneous and Paddle Electrodes for Spinal Cord Stimulation

Neuromodulation, 2016 · DOI: 10.1111/ner.12370 · Published: January 1, 2016

Simple Explanation

Spinal cord stimulation (SCS) is used to treat chronic pain syndromes. While generally considered safe, a rare but serious complication is spinal cord injury (SCI). This study aims to quantify the incidence of SCI following SCS implantation using both percutaneous and paddle electrodes. Researchers reviewed a large database of patients who underwent SCS implantation between 2000 and 2009. They looked for cases of SCI and spinal hematoma within 30 days after the procedure. The study found that the overall incidence of SCI was low (2.13%), suggesting that SCS is a relatively safe procedure. There was no significant difference in SCI rates between percutaneous and paddle electrode implantation.

Study Duration

2000 to 2009

Participants

8,326 patients (percutaneous 5,458 vs. paddle: 2,868)

Evidence Level

Retrospective review

Key Findings

1
The overall incidence of SCI was 2.13% in patients undergoing SCS implantation.
2
There was no statistically significant difference in the incidence of SCI between percutaneous (2.35%) and paddle (1.71%) electrode implantation (p = 0.0556).
3
Taking any anticoagulant within 30 days prior to the procedure increased the odds of SCI.

Research Summary

This retrospective study examined the incidence of spinal cord injury (SCI) following spinal cord stimulation (SCS) implantation using percutaneous and paddle electrodes between 2000 and 2009. The study found a low overall incidence of SCI (2.13%) with no significant difference between percutaneous and paddle electrode implantation. The use of anticoagulants prior to the procedure was associated with an increased risk of SCI. Further research is needed to understand the mechanisms of SCI in SCS.

Practical Implications

Informed Consent

Patients should be informed about the risk of SCI, even though it is low, before undergoing SCS.

Anticoagulant Management

Careful consideration should be given to the use of anticoagulants prior to SCS, and strategies to minimize bleeding risk should be implemented.

Further Research

Future studies should focus on identifying specific risk factors and mechanisms of SCI in SCS to further improve patient safety.

Study Limitations

1
Retrospective, nonrandomized design
2
Inability to evaluate the severity and duration of neurologic deficits sustained by patients
3
Inability to determine the exact mechanism of spinal cord injury

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