Kim Samuel H, Lopez Ramos Christian G, Palan Mihir J, Kronquist Elise, Tan Hao, Elkholy Mohamed Amgad Elsayed, Raslan Ahmed
Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA.
Department of Neurosurgery, Ain Shams University, Cairo, Egypt.
Stereotact Funct Neurosurg. 2025;103(1):24-34. doi: 10.1159/000541445. Epub 2024 Oct 29.
Spinal cord stimulation (SCS) is an effective treatment for patients with refractory chronic pain. Despite its efficacy, rates of reoperation after initial implantation of SCS remain high. While revision rates after index SCS surgeries are well reported, less is known about rates and risk factors associated with repeat reoperations. We sought to evaluate patient, clinical, and surgical characteristics associated with repeat reoperation among patients who underwent an initial SCS revision procedure.
We performed a retrospective review of patients who underwent SCS revision surgery performed at a single institution between 2008 and 2022. Patients were stratified by whether they underwent a single revision (SR) or multiple revision (MR) surgeries. Multivariate logistic regression was performed to determine risk factors associated with repeat SCS revision. Kaplan-Meier survival analysis was used to compare rates of devices requiring revision across groups.
A total of 54 patients underwent an initial SCS revision. Of these, 15 (28%) underwent a second revision. The most common indication for revision surgery was lead migration (65%). No significant differences were observed in age, body mass index, comorbidities, lead type, and revision indication among the SR and MR groups. On multivariate adjusted analysis, only cervical lead position was significantly associated with repeat reoperation (OR 7.10, 95% CI [1.14, 44.3], p = 0.036). Time to reoperation after a single and MR SCS surgeries did not differ.
Among patients who undergo SCS reoperation, a substantial portion requires additional revisions. Cervical lead placement may be associated with a higher risk of repeat revision surgery compared to thoracic lead positioning. Consideration of lead positioning in the decision to perform and undergo reoperation may therefore result in lower revision rates and improved clinical outcomes among SCS patients with MRs.
脊髓刺激（SCS）是治疗难治性慢性疼痛患者的一种有效方法。尽管其疗效显著，但SCS初次植入后的再次手术率仍然很高。虽然初次SCS手术后的翻修率已有充分报道，但对于重复再次手术的发生率和危险因素了解较少。我们旨在评估初次SCS翻修手术患者中与重复再次手术相关的患者、临床和手术特征。
我们对2008年至2022年在单一机构接受SCS翻修手术的患者进行了回顾性研究。患者根据是否接受单次翻修（SR）或多次翻修（MR）手术进行分层。进行多因素逻辑回归分析以确定与重复SCS翻修相关的危险因素。采用Kaplan-Meier生存分析比较各组需要翻修的装置发生率。
共有54例患者接受了初次SCS翻修。其中，15例（28%）接受了二次翻修。翻修手术最常见的指征是电极移位（65%）。SR组和MR组在年龄、体重指数、合并症、电极类型和翻修指征方面未观察到显著差异。在多因素调整分析中，只有颈部电极位置与重复再次手术显著相关（比值比7.10，95%置信区间[1.14, 44.3]，p = 0.036）。单次和MR SCS手术后再次手术的时间无差异。
在接受SCS再次手术的患者中，相当一部分需要额外的翻修。与胸部电极放置相比，颈部电极放置可能与更高的重复翻修手术风险相关。因此，在决定进行和接受再次手术时考虑电极位置可能会降低SCS患者MRs的翻修率并改善临床结局。
