Papadopoulos Dimitrios V, Suk Madeline S, Andreychik David, Nikolaou Vasileios, Haak Michael
Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA, USA.
2nd Academic Department of Orthopaedics, School of Medicine, Konstandopoulio General Hospital, National & Kapodistrian University of Athens, Athens, Greece.
Global Spine J. 2025 Mar;15(2):467-473. doi: 10.1177/21925682231194466. Epub 2023 Aug 5.
Retrospective study.
Spinal cord stimulation has been mainly used for the management of postsurgical persistent neuropathic. The purpose of the study was to evaluate the rate and causes for reoperation following spinal cord stimulation, and to identify risk factors for reoperation.
A retrospective study was conducted including patients who underwent surgical implantation of spinal cord stimulators within a 10-year period. The medical records of the included patients were reviewed for reoperations, demographics and certain clinical parameters. Demographics and clinical parameters were compared between patients with and without reoperations, and between patients with and without surgical site infections.
Overall, 1014 index procedures and 175 reoperations were performed within the study period. At least 1 reoperation was performed in 97 (9.5%) cases. The most common cause for revision was lead migration or lead misplacement (n = 31, 3.0%). In 31 (3.1%) cases the stimulator was removed due to no pain relief. Surgical site infection that required reoperation developed in 30 cases (2.9%). Younger age was associated with a need for reoperation (Odds Ratio [OR]: .97,95% Confidence Interval [CI]:0.95-.99, = .005), while higher Body Mass index and diabetes were associated with development of infection (OR: 1.05, 95% CI: 1.00-1.11, = .036 and OR: 2.42, 95% CI: 1.05-5.47, = .033 respectively).
The results of this study indicate that certain measures could improve the overall reoperation rate after spinal cord stimulation, such as accurate positioning of the spinal cord stimulators and design of smaller generators. Moreover, preoperative optimization of patients could result in lower complication rate, lower reoperations rate, and subsequently better clinical outcomes.
回顾性研究。
脊髓刺激主要用于术后持续性神经病变的管理。本研究的目的是评估脊髓刺激术后再次手术的发生率及原因，并确定再次手术的危险因素。
进行一项回顾性研究，纳入在10年内接受脊髓刺激器手术植入的患者。回顾纳入患者的病历，了解再次手术情况、人口统计学资料及某些临床参数。比较有再次手术和无再次手术患者之间，以及有手术部位感染和无手术部位感染患者之间的人口统计学资料和临床参数。
总体而言，在研究期间共进行了1014例初次手术和175例再次手术。97例（9.5%）患者至少进行了1次再次手术。最常见的翻修原因是电极移位或电极放置不当（n = 31，3.0%）。31例（3.1%）患者因疼痛未缓解而取出刺激器。30例（2.9%）患者发生了需要再次手术的手术部位感染。年龄较小与再次手术需求相关（比值比[OR]：0.97，95%置信区间[CI]：0.95 - 0.99，P = 0.005），而较高的体重指数和糖尿病与感染发生相关（OR分别为：1.05，95% CI：1.00 - 1.11，P = 0.036；OR：2.42，95% CI：1.05 - 5.47，P = 0.033）。
本研究结果表明，某些措施可提高脊髓刺激术后的总体再次手术率，如脊髓刺激器的精确定位和更小发生器的设计。此外，术前对患者进行优化可降低并发症发生率、降低再次手术率，进而改善临床结局。
