Day Wesley, Maloy Gwyneth C, Winter Adam D, Chapman Kenneth B, Seddio Anthony E, Doshi Rushabh H, Ratnasamy Philip P, Varthi Arya G, Fourman Mitchell S, Grauer Jonathan N
Department of Orthopaedics & Rehabilitation, Yale School of Medicine, New Haven, CT, United States.
Department of Orthopedic Surgery, Montefiore Einstein Health System, Bronx, NY, United States.
N Am Spine Soc J. 2025 May 14;22:100616. doi: 10.1016/j.xnsj.2025.100616. eCollection 2025 Jun.
BACKGROUND: Spinal cord stimulators (SCS) are neuromodulatory devices that may be considered for refractory back or neurologic pain. Trends in SCS utilization and factors associated with failure of trial-to-implant conversion are not well defined. METHODS: Using the 2010 - 2022 PearlDiver Mariner Patient Claims Database, adults who underwent SCS trial were identified and categorized into those who did or did not undergo conversion to permanent SCS implantation. Multivariable logistic regression was used to identify clinical (age, sex, Elixhauser Comorbidity Index, and tobacco use) and non-clinical (insurance plan and US geographic region) characteristics associated with lower odds of trial-to-implant conversion.The annual incidences of SCS utilization, trial-to-implant conversion, and breakdown of specialties performing SCS implantation (pain specialists, neurosurgeons, orthopedic surgeons) were analyzed. RESULTS: Of 265,756 patients undergoing SCS trial, 178,144 (67%) went on to receive permanent implant while 87,612 (33%) did not. Factors independently associated with lower odds of successful trial-to-implant conversion included: older age (OR: 0.97 per decade increase), male sex (OR: 0.93, relative to female), lower comorbidity burden (OR: 0.96 per 1-point ECI decrease), no documented tobacco use (OR: 0.94), insurance (relative to Commercial, Medicaid [OR: 0.78] and Medicare [OR: 0.85]) and geographic region (relative to Midwest, Northeast [OR: 0.63], West [OR: 0.82], and South [OR: 0.85]) ( < 0.05 for all).The incidence of SCS trialing increased over the years from 17.9 to 22.9 patients per 100,000 covered lives in the database ( < 0.05). The rate of successful trial-to-implant conversion increased from 63.4% in 2010 to 73.3% in 2021 ( < 0.05). The breakdown of physician specialties implanting SCS remained similar over the years. CONCLUSIONS: The overall utilization of SCS and trial-to-implant conversion rates have increased over the years. By defining clinical and nonclinical factors associated with failure for conversion from trial to implant, selection processes can be further optimized by specialists performing these procedures.
背景：脊髓刺激器（SCS）是一种神经调节装置，可用于治疗顽固性背痛或神经痛。SCS的使用趋势以及与试验性植入转换失败相关的因素尚未明确界定。 方法：利用2010 - 2022年PearlDiver Mariner患者索赔数据库，识别接受SCS试验的成年人，并将其分为进行或未进行永久性SCS植入转换的两组。采用多变量逻辑回归分析来确定与试验性植入转换几率较低相关的临床（年龄、性别、埃利克斯豪泽合并症指数和吸烟情况）和非临床（保险计划和美国地理区域）特征。分析了SCS的使用年发病率、试验性植入转换率以及进行SCS植入的专业细分情况（疼痛科医生、神经外科医生、骨科医生）。 结果：在265,756例接受SCS试验的患者中，178,144例（67%）继续接受永久性植入，而87,612例（33%）未接受。与试验性植入转换成功几率较低独立相关的因素包括：年龄较大（每增加十岁，比值比：0.97）、男性（相对于女性，比值比：0.93）、合并症负担较轻（每降低1分埃利克斯豪泽合并症指数，比值比：0.96）、无吸烟记录（比值比：0.94）、保险类型（相对于商业保险，医疗补助[比值比：0.78]和医疗保险[比值比：0.85]）以及地理区域（相对于中西部，东北部[比值比：0.63]、西部[比值比：0.82]和南部[比值比：0.85]）（所有P<0.05）。数据库中SCS试验的发病率多年来从每10万参保人口17.9例增加到22.9例（P<0.05）。试验性植入转换成功率从2010年的63.4%提高到2021年的73.3%（P<0.05）。多年来进行SCS植入的医生专业细分情况保持相似。 结论：多年来SCS的总体使用率和试验性植入转换率有所提高。通过确定与试验性植入转换失败相关的临床和非临床因素，进行这些操作的专科医生可以进一步优化选择过程。
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