Retrospective Review of Efficacy and Safety of Spinal Cord Stimulators (SCS)

Location

Medical Education Building, LSUHSC-NO

Presentation Date

10-10-2019 10:00 AM

End Date

10-10-2019 12:00 PM

Description

ABSTRACT Objectives: Spinal cord stimulation (SCS) has been shown to be an effective and safe option to treat patients with intractable pain in the general population. Spinal cord stimulation is most often used in people suffering from failed back surgery syndrome, and it has been shown to elicit better pain relief and higher satisfaction levels than surgical reoperations for those with failed back surgery syndrome. Our study seeks to confirm that United States military veterans are getting effective and safe treatment for pain management similar to their non-veteran peers. Methods and Materials: We reviewed electronic medical records and conducted phone interviews with 51 veterans who had SCS from 2008-2019 at the New Orleans Veterans Affairs Medical Center of New Orleans. Patients were called and asked for their consent and then afterwards given a survey. The survey included Pain Outcome Questionnaires and questions about side effects/complications, ability to decrease opioid use, manufacturer of device, device placed via percutaneous or laminectomy, and would the patient recommend spinal cord stimulation to peers. Our primary outcome measure was whether veterans would recommend SCS to their peers. We feel that veterans would only recommend SCS if they benefitted from it, and it was safe. Secondary outcome measures were improvements in activities of daily living and ability to decrease opioid pain medications. Results: 75% of veterans recommended SCS to their peers. There were significant reductions in pain levels following SCS implantation, as well as significant reductions in the effect of pain on walking, carrying objects, climbing stairs, bathing, getting dressed, using the bathroom, and grooming. Additionally, SCS resulted in significantly improved levels of self-esteem, physical activity, energy levels, strength and endurance, and feelings of safety while exercising, while also decreasing one’s feelings of depression, anxiety, tension, and fear of reinjury. There were no permanent neurological deficits or deaths as a result of SCS. One patient developed an infection overlying the generator site 8 months post-implant; this was treated with generator explant, and there were no neurological sequelae. Interestingly, this patient who had explant reported only 30% pain relief, and he was eager to get a new generator implanted. Conclusion: SCS is effective and safe for veterans in this review at the New Orleans VA Medical Center. Limitations: This study is not randomized. It is retrospective and is a subjective questionnaire. Keywords: spinal cord stimulator, neuromodulation, failed back surgery syndrome, post-laminectomy syndrome, lumbar radiculopathy. Conflicts of Interest: The authors have no financial interests in the material or devices described in this article and received no financial support in the generation of this submission.

Comments

Mentor: Casey A. Murphy, M.D., F.A.A.P.M.R. (Southeast Louisiana Veterans Health Care System)

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Oct 10th, 10:00 AM Oct 10th, 12:00 PM

Retrospective Review of Efficacy and Safety of Spinal Cord Stimulators (SCS)

Medical Education Building, LSUHSC-NO

ABSTRACT Objectives: Spinal cord stimulation (SCS) has been shown to be an effective and safe option to treat patients with intractable pain in the general population. Spinal cord stimulation is most often used in people suffering from failed back surgery syndrome, and it has been shown to elicit better pain relief and higher satisfaction levels than surgical reoperations for those with failed back surgery syndrome. Our study seeks to confirm that United States military veterans are getting effective and safe treatment for pain management similar to their non-veteran peers. Methods and Materials: We reviewed electronic medical records and conducted phone interviews with 51 veterans who had SCS from 2008-2019 at the New Orleans Veterans Affairs Medical Center of New Orleans. Patients were called and asked for their consent and then afterwards given a survey. The survey included Pain Outcome Questionnaires and questions about side effects/complications, ability to decrease opioid use, manufacturer of device, device placed via percutaneous or laminectomy, and would the patient recommend spinal cord stimulation to peers. Our primary outcome measure was whether veterans would recommend SCS to their peers. We feel that veterans would only recommend SCS if they benefitted from it, and it was safe. Secondary outcome measures were improvements in activities of daily living and ability to decrease opioid pain medications. Results: 75% of veterans recommended SCS to their peers. There were significant reductions in pain levels following SCS implantation, as well as significant reductions in the effect of pain on walking, carrying objects, climbing stairs, bathing, getting dressed, using the bathroom, and grooming. Additionally, SCS resulted in significantly improved levels of self-esteem, physical activity, energy levels, strength and endurance, and feelings of safety while exercising, while also decreasing one’s feelings of depression, anxiety, tension, and fear of reinjury. There were no permanent neurological deficits or deaths as a result of SCS. One patient developed an infection overlying the generator site 8 months post-implant; this was treated with generator explant, and there were no neurological sequelae. Interestingly, this patient who had explant reported only 30% pain relief, and he was eager to get a new generator implanted. Conclusion: SCS is effective and safe for veterans in this review at the New Orleans VA Medical Center. Limitations: This study is not randomized. It is retrospective and is a subjective questionnaire. Keywords: spinal cord stimulator, neuromodulation, failed back surgery syndrome, post-laminectomy syndrome, lumbar radiculopathy. Conflicts of Interest: The authors have no financial interests in the material or devices described in this article and received no financial support in the generation of this submission.