Huang Kevin T, Martin Joel, Marky Andrew, Chagoya Gustavo, Hatef Jeff, Hazzard Matthew A, Thomas Steven M, Lokhnygina Yuliya, Lad Shivanand P
Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
Neuromodulation. 2015 Feb;18(2):133-9; discussion 139-40. doi: 10.1111/ner.12199. Epub 2014 Jun 13.
Conversion rates from trial leads to permanent spinal cord stimulation (SCS) systems have recently come under scrutiny. Our goal was to examine the rate of conversion from trial lead to permanent system placement as well as identify factors associated with successful SCS conversion.
We designed a large retrospective analysis using the Thomson Reuters MarketScan database. We included all patients who underwent a percutaneous trial of neurostimulatory electrodes from the years 2000 to 2009 who were aged 18 and older. Patients were then tracked to see if they went on to receive a permanent SCS system. Patients were also analyzed in univariate and multivariate models to identify factors associated with successful conversion.
A total of 21,672 unique instances of percutaneous trials were identified. Overall, 41.4% of those receiving trials went on to have a permanent SCS system installed within the subsequent three months. Factors associated with increased likelihood of successful conversion included having commercial insurance (43% vs. 37%, p < 0.0001), younger age (43% for those aged 35-44 vs. 39% for those aged 65 and older, p < 0.0001), and never having had a previous percutaneous trial attempt (44% for first-time trials vs. 27% for those on their second trial vs. 14% for those on their third or later trial, p < 0.0001). In multivariate analysis, we found significant variation in conversion rate by geographic area (patients in the North Central region vs. Northeast region: odds ratio 1.48, 95% confidence interval [1.31, 1.66]; p < 0.0001).
In this study of a national cohort of patients, we identified specific factors associated with higher conversion rates, along with significant geographical variation. In general, there is a need for better patient selection by physicians who practice neuromodulation.
近期，试验性导联转换为永久性脊髓刺激（SCS）系统的转化率受到了审查。我们的目标是研究试验性导联转换为永久性系统植入的比率，并确定与成功进行SCS转换相关的因素。
我们使用汤森路透市场扫描数据库设计了一项大型回顾性分析。我们纳入了2000年至2009年间接受经皮神经刺激电极试验的所有18岁及以上患者。然后对患者进行跟踪，观察他们是否继续接受永久性SCS系统。还对患者进行了单因素和多因素模型分析，以确定与成功转换相关的因素。
共识别出21,672例经皮试验的独特病例。总体而言，接受试验的患者中有41.4%在随后三个月内继续植入了永久性SCS系统。与成功转换可能性增加相关的因素包括拥有商业保险（43%对37%，p<0.0001）、年龄较小（35 - 44岁患者为43%，65岁及以上患者为39%，p<0.0001）以及从未进行过经皮试验尝试（首次试验患者为44%，第二次试验患者为27%，第三次或更多次试验患者为14%，p<0.0001）。在多因素分析中，我们发现不同地理区域的转换率存在显著差异（中北部地区患者与东北地区患者：优势比1.48，95%置信区间[1.31, 1.66]；p<0.0001）。
在这项对全国患者队列的研究中，我们确定了与较高转换率相关的特定因素以及显著的地理差异。总体而言，神经调节治疗的医生需要更好地进行患者选择。
