The following is a summary of “Spinal Cord Stimulation Explantation and Chronic Pain: A Systematic Review and Technology Recommendations,” published in the March 2025 issue of Journal of Pain Research by Wahezi et al.
Chronic pain affects 20.5% of individuals, with spinal cord stimulation (SCS) emerging as a vital treatment, though concerns remain about its long-term durability and explantation rates.
Researchers conducted a retrospective study to assess SCS explantation rates, identify underlying causes, and assess the financial impact on the healthcare system.
They utilized 3 screening methods: manual keyword search, Medical Subject Headings (MeSH) term query, and reference list screening. The search spanned PubMed, Cochrane, and Web of Science databases from inception to November 2024, identifying 719 articles. After applying the eligibility criteria, 72 articles met the inclusion criteria, and 25 were selected for analysis. Independent reviewers extracted data, while a second reviewer verified accuracy. Any discrepancies were resolved by the corresponding editor.
The results showed that data from 13,026 individuals who underwent permanent SCS implantation between 1984 and 2024 across 25 studies were analyzed. A total of 1,882 individuals (9.82%) required explantation. The most frequent cause was lack of efficacy and insufficient pain relief (38%), followed by lead failure (15%) and infection (14%). Although SCS showed overall effectiveness, concerns remained regarding device longevity and individual satisfaction, with explantation rates influenced by technical failures and inadequate pain relief.
Investigators concluded that despite its safety and effectiveness, SCS exhibited variable efficacy and high explantation rates, particularly within the first year due to insufficient pain relief, coupled with substantial implantation and revision costs and limited waveform flexibility in the hardware-centric model, necessitating innovative solutions.
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