Incidence of Revision Surgery in a Large Cohort of Patients With Thoracic Surgical Three-Column Paddle Leads: A Retrospective Case Review

Objectives: Spinal cord stimulation (SCS) revision surgery remains common, with a negative impact on cost-effectiveness and outcomes. The primary goal in this report was to retrospectively study the need for revision surgery in a large cohort of patients with newly implanted thoracic surgical three-column paddle leads, focusing on a method of implantation to reduce the need for revision surgery. Clinical outcomes were also assessed. Methods: The outcomes in 126 patients who received initial surgical paddle SCS implants for back and/or leg pain from 2008 to 2012 were retrospectively analyzed. A disinterested third party performed chart reviews and telephone interviews. A single surgeon with a consistent method performed all implants, with no lead anchoring. All three major commercial vendors were utilized. Results: There were no paddle electrode lead revisions required for spontaneous fracture, migration, or infection at an average chart-review follow-up period of 20 months. With subsequent telephone interviews, a 65% clinical success rate was seen at 29 months. Significant suboptimal stimulation with body-position changes (SSBPC) was reported in less than 10% of patients. All results were vendor-independent. Conclusions: This report, the largest to date on patients with three-column paddle leads, shows low electrode revision rates with expected clinical success rates. Clinically relevant SSBPC was uncommon.