Hussain Nasir, Karri Jay, Dimitrov Theodore, D'Souza Ryan S, Zhou Steven, Abdel-Rasoul Mahmoud, Abd-Elsayed Alaa, Gill Jatinder, Simopoulos Thomas, Weaver Tristan E
Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Neuromodulation. 2024 Aug;27(6):1068-1075. doi: 10.1016/j.neurom.2022.06.008. Epub 2022 Aug 14.
Inadvertent dural puncture (IDP) is a known complication associated with traditional neuraxial procedures; however, its characterization after percutaneous spinal cord stimulation (SCS) lead placement has yet to be clearly established in large population studies. This retrospective analysis aims to understand the incidence and associated characteristics of patients with IDP after percutaneous SCS lead placement.
The PearlDiver Mariner database of national all-payer claims was used to identify patients who received percutaneous SCS leads and had a claim for IDP (intraoperative IDP or postdural puncture headache [PDPH] claim) within 45 days. The primary outcome was to determine the overall incidence of IDP. Secondary outcomes included an evaluation of associated risk factors for IDP and treatments used in symptomatic management.
A total of 90,952 patients who underwent percutaneous lead SCS placement were included. The incidence of IDP was 0.48% (436/90,952 patients). Older age (odds ratio [OR]: 0.96; 95% CI: 0.95-0.97; p < 0.0001) and male sex (OR: 0.66; 95% CI: 0.53-0.81; p < 0.001) had a lower odds of having a claim for IDP, whereas a history of IDP was associated with a higher OR (95% CI) by 13.72 times (10.72-17.58) (p < 0.0001). Of the IDP patients, 64% (277/436 patients) had a claim for a therapeutic blood patch. Discrepancy in type of claim for IDP was observed, with most being for PDPH.
Our findings suggest that IDP after percutaneous SCS lead placement is an uncommon event; however, certain factors are associated with its development. Overall, early recognition of IDP after percutaneous SCS lead placement is imperative to facilitate the delivery of targeted treatments and prevent further harmful consequences to the patient.
硬膜外穿刺（IDP）是传统神经轴突手术已知的并发症；然而，在经皮脊髓刺激（SCS）导线置入后其特征在大型人群研究中尚未明确确立。本回顾性分析旨在了解经皮SCS导线置入后IDP患者的发生率及相关特征。
使用国家所有支付方索赔的PearlDiver Mariner数据库来识别接受经皮SCS导线置入且在45天内有IDP索赔（术中IDP或硬膜穿刺后头痛[PDPH]索赔）的患者。主要结局是确定IDP的总体发生率。次要结局包括对IDP相关危险因素及对症治疗所用治疗方法的评估。
共纳入90952例行经皮导线SCS置入的患者。IDP的发生率为0.48%（436/90952例患者）。年龄较大（比值比[OR]：0.96；95%置信区间[CI]：0.95 - 0.97；p < 0.0001）和男性（OR：0.66；95% CI：0.53 - 0.81；p < 0.001）发生IDP索赔的几率较低，而既往有IDP病史与较高的OR（95% CI）相关，高出约13.72倍（10.72 - 17.58）（p < 0.0001）。在IDP患者中，64%（277/436例患者）有治疗性血液补片索赔。观察到IDP索赔类型存在差异，大多数为PDPH。
我们的研究结果表明，经皮SCS导线置入后发生IDP是一种罕见事件；然而，某些因素与其发生相关。总体而言，经皮SCS导线置入后对IDP的早期识别对于促进针对性治疗的实施和防止对患者造成进一步有害后果至关重要。
