Hines Kevin, Swaminathan Vishal, Thalheimer Sara, Kogan Michael, Wu Chengyuan, Sharan Ashwini
Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Neuromodulation. 2022 Oct;25(7):1040-1044. doi: 10.1111/ner.13498. Epub 2022 Feb 15.
Dorsal root ganglion (DRG) stimulation is a form of neuromodulation used to treat neuropathic pain due to a myriad of etiologies. Though this relatively new therapy has been shown to be quite effective, complications associated with the implantation of this therapy have not been well documented.
The primary objective of this study was to describe the device-related complications associated with DRG stimulator implantations.
This was a single-center retrospective analysis of 31 patients who underwent full implantation of neuromodulation hardware marketed for DRG stimulation. The predefined endpoints included device-related complications associated with DRG implantations, such as hardware failure, explantation procedures, and revision surgery. Additional endpoints included percentage of patients receiving therapy and pain as measured using the visual analog scale (VAS) pain scale at initial, six-month, and 12-month follow-up after hardware implantation.
Thirty-one patients were included out of 42 patients trialed. Baseline VAS in patients was 7.7 (31 patients). At initial follow-up, six-month follow-up, and one-year follow-up, VAS scores were 4.7 (31 patients), 5.3 (20 patients), and 5.5 (13 patients), respectively. Paired t-test between preoperative VAS (mean 7.3) and one-year follow-up VAS (5.5) demonstrated statistical significance (p = 0.027). At initial, six-month, and one-year follow-up, 30/31 (97%), 19/24 (79%), and 18/23 (78%) patients were confirmed to be receiving DRG stimulation therapy after permanent implant. Of the 31 patients who were implanted with a permanent system, 8 (26%) were explanted and an additional 10 (29%) required revision surgery.
In this study, we examine the various device-related complications associated with DRG stimulation requiring repeat surgery. High rates of hardware failure, revision surgery, and explantation of stimulators illustrate the need for hardware optimization to improve patient outcomes.
背根神经节(DRG)刺激是一种神经调节方式,用于治疗多种病因引起的神经性疼痛。尽管这种相对较新的疗法已被证明相当有效,但与该疗法植入相关的并发症尚未得到充分记录。
本研究的主要目的是描述与DRG刺激器植入相关的器械相关并发症。
这是一项对31例接受用于DRG刺激的神经调节硬件完全植入的患者进行的单中心回顾性分析。预定义的终点包括与DRG植入相关的器械相关并发症,如硬件故障、取出手术和翻修手术。其他终点包括接受治疗的患者百分比以及在硬件植入后的初始、六个月和十二个月随访时使用视觉模拟量表(VAS)疼痛量表测量的疼痛程度。
在42例试验患者中,纳入了31例。患者的基线VAS为7.7(31例患者)。在初始随访、六个月随访和一年随访时,VAS评分分别为4.7(31例患者)、5.3(20例患者)和5.5(13例患者)。术前VAS(平均7.3)与一年随访VAS(5.5)之间的配对t检验显示具有统计学意义(p = 0.027)。在初始、六个月和一年随访时,30/31(97%)、19/24(79%)和18/23(78%)的患者在永久植入后被确认接受DRG刺激治疗。在31例植入永久系统的患者中,8例(26%)被取出,另外10例(29%)需要翻修手术。
在本研究中,我们检查了与需要重复手术的DRG刺激相关的各种器械相关并发症。硬件故障、翻修手术和刺激器取出的高发生率表明需要对硬件进行优化以改善患者预后。