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Spinal Cord Stimulators and Intrathecal Pain Pump Removal Versus Retention During Posterior Lumbar Fusion: A Matched Cohort Analysis – Lumbar Fusion

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This article is a retrospective cohort study that aims to determine the risks associated with posterior lumbar arthrodesis (fusion) after the insertion of a spinal cord stimulator (SCS) or intrathecal pain pump (IPP). The study used the PearlDiver Mariner database to identify patients who underwent spinal fusion between 2010 and 2020 and created study groups for patients with and without SCS or IPP. The results show that patients with SCS or IPP had higher rates of revision surgery, instrumentation failure, and pulmonary, surgical site, and urinary complications compared to patients without these devices. The study also found that there were no differences in complications between patients with SCS or IPP whether the device was removed or retained during fusion surgery

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most specialised spine facility on Harley Street UK

Published article

CONCLUSIONS: Patients with a history of spinal cord stimulators and intrathecal pain pumps are at increased risk of mechanical complications and revision fusion compared with patients without these devices. Patients with an SCS or IPP have similar rates of complications during lumbar fusion whether the device is removed or retained.

Lumbar Fusion Surgery Expert. Best Spinal Surgeon UK
Clin Spine Surg. 2023 Jul 21. doi: 10.1097/BSD.0000000000001502. Online ahead of print.ABSTRACTSTUDY DESIGN: Retrospective cohort study.OBJECTIVE: To determine risks associated with posterior lumbar arthrodesis after spinal cord stimulator (SCS) and intrathecal pain pump (IPP) insertion.SUMMARY OF BACKGROUND DATA: SCS and IPPs aid in the management of chronic back and radicular pain. Little is known regarding,

Clin Spine Surg. 2023 Jul 21. doi: 10.1097/BSD.0000000000001502. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective cohort study.

OBJECTIVE: To determine risks associated with posterior lumbar arthrodesis after spinal cord stimulator (SCS) and intrathecal pain pump (IPP) insertion.

SUMMARY OF BACKGROUND DATA: SCS and IPPs aid in the management of chronic back and radicular pain. Little is known regarding the risks of subsequent fusion with these devices in place.

METHODS: The PearlDiver Mariner database was queried for spinal fusion between 2010 and 2020. Study groups were created for indwelling SCS or IPP and matched to a separate cohort without SCS or IPP. Subgroups were created for those who had their device removed and those who retained their device at the time of surgery. Complications up to 2 years postoperatively were reviewed and confounding variables were controlled using multivariable logistic regression.

RESULTS: Four thousand five hundred three patients had an indwelling SCS/IPP and underwent posterior lumbar fusion. Compared with patients without history of an SCS/IPP, patients undergoing a lumbar fusion with an SCS/IPP which was removed or retained had higher rates of revision surgery at 1 year [7.3% vs. 5.0%, odds ratio (OR) =1.48, P<0.001] and 2 year (10.8% vs. 7.0%, OR =1.59, P<0.001). For all time intervals, there were higher odds of instrumentation failure (2 y: OR =1.65, P<0.001), and pulmonary complications (2 y: OR =1.18, P<0.001). At 2 years, there were higher odds of surgical site complications (OR 1.15, P=0.02) and urinary complications (OR=1.07, P=0.04). There were no differences in complications up to 2 years postoperatively in patients with an SCS/IPP who had their devices retained or removed (P>0.05).

CONCLUSIONS: Patients with a history of spinal cord stimulators and intrathecal pain pumps are at increased risk of mechanical complications and revision fusion compared with patients without these devices. Patients with an SCS or IPP have similar rates of complications during lumbar fusion whether the device is removed or retained.

PMID:37482636 | DOI:10.1097/BSD.0000000000001502

The London Spine Unit : most specialised spine facility on Harley Street UK

Read the original publication:

Spinal Cord Stimulators and Intrathecal Pain Pump Removal Versus Retention During Posterior Lumbar Fusion: A Matched Cohort Analysis

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Clin Spine Surg. 2023 Jul 21. doi: 10.1097/BSD.0000000000001502. Online ahead of print.ABSTRACTSTUDY DESIGN: Retrospective cohort study.OBJECTIVE: To determine risks associated with posterior lumbar arthrodesis after spinal cord stimulator (SCS) and intrathecal pain pump (IPP) insertion.SUMMARY OF BACKGROUND DATA: SCS and IPPs aid in the management of chronic back and radicular pain. Little is known regarding

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