Abstract #108: Using BurstDR to Salvage Loss of Efficacy in Dorsal Column Spinal Cord Stimulation

Abstract

Introduction: Loss of efficacy (LOE) is a well-known complication and the leading cause of explant associated with traditional dorsal column spinal cord stimulation (DC-SCS). LOE is a dreaded and poorly understood phenomenon with a significant effect on quality of life, economic burden, as well as a serious impact on emotional and psychological well-being. Previously, the only option for stimulation was tonic pulse trains below 1500 Hz thus neuromodulators had little to no methods for salvage (i.e. "stim holidays") as there were no other alternatives and were left with contemplating explant of the system and consideration of targeted drug delivery as a final option. Recently, different options for frequency (10,000 Hz) and pulse train (BurstDR) were made available thus allowing neuromodulators to "swap" one therapy for another in the event of LOE. Little is known about the utility of replacing a monophasic implantable pulse generator (IPG) with a multivariable waveform IPG, in the setting of DC-SCS LOE. We present a case series of seven patients who experienced LOE with tonic (traditional and high frequency) and were successfully salvaged by replacing their IPG with a system capable of BurstDR.