Babu Ranjith, Hazzard Matthew A, Huang Kevin T, Ugiliweneza Beatrice, Patil Chirag G, Boakye Maxwell, Lad Shivanand P
Department of Surgery, Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
Neuromodulation. 2013 Sep-Oct;16(5):418-26; discussion 426-7. doi: 10.1111/ner.12065. Epub 2013 May 3.
Spinal cord stimulation (SCS) is a well-established modality for the treatment of chronic pain, and can utilize percutaneous or paddle leads. While percutaneous leads are less invasive, they have been shown to have higher lead migration rates. In this study, we compared the long-term outcomes and health-care costs associated with paddle and percutaneous lead implantation.
We utilized the MarketScan data base to examine patients who underwent percutaneous or paddle lead SCS system implantation from 2000 to 2009. Outcomes including complications, reoperation rates, and health-care costs were evaluated in propensity score matched cohorts using univariate and multivariate analyses.
The study cohort was comprised of 13,774 patients. At 90 days following the initial procedure, patients in the SCS paddle group were more likely to develop a postoperative complication than patients receiving percutaneous systems (3.4% vs. 2.2%, p = 0.0005). Two-year (6.3% vs. 3.5%, p = 0.0056) and long-term (five+ years) (22.9% vs. 8.5%, p < 0.0008) reoperation rates were significantly higher in those with percutaneous lead systems. However, long-term health-care costs were similar for those receiving paddle and percutaneous leads ($169,768 vs. $186,139, p = 0.30).
While the implantation of paddle leads is associated with slightly higher initial postoperative complications, these leads are associated with significantly lower long-term reoperation rates. Nonetheless, long-term health-care costs are similar between paddle and percutaneous leads. Additional improvements in SCS technologies that address the shortcomings of current systems are needed to reduce the risk of reoperation due to hardware failure. Further study is required to evaluate the efficacy of newer percutaneous and paddle SCS systems and examine their comparative outcomes.
脊髓刺激（SCS）是一种成熟的慢性疼痛治疗方式，可使用经皮或板状电极导联。虽然经皮导联侵入性较小，但已证明其导联迁移率较高。在本研究中，我们比较了板状电极导联和经皮导联植入的长期疗效及医疗成本。
我们利用MarketScan数据库，研究2000年至2009年接受经皮或板状电极导联SCS系统植入的患者。在倾向评分匹配队列中，采用单因素和多因素分析评估包括并发症、再次手术率和医疗成本在内的疗效。
研究队列包括13774例患者。在初次手术后90天，SCS板状电极导联组患者比接受经皮系统的患者更易发生术后并发症（3.4%对2.2%，p = 0.0005）。经皮导联系统患者的两年（6.3%对3.5%，p = 0.0056）和长期（五年以上）（22.9%对8.5%，p < 0.0008）再次手术率显著更高。然而，接受板状电极导联和经皮导联的患者长期医疗成本相似（169768美元对186139美元，p = 0.30）。
虽然板状电极导联植入术后初期并发症略多，但这些导联的长期再次手术率显著更低。尽管如此，板状电极导联和经皮导联的长期医疗成本相似。需要对SCS技术进行更多改进以解决现有系统的缺点，从而降低因硬件故障导致再次手术的风险。需要进一步研究以评估新型经皮和板状电极SCS系统的疗效并检查其比较结果。
