Abstract
The science of neuromodulation has made many great advances in the recent past. Despite a variety of improvements in technology, usability, ease of use there continues to exist a failure rate leading to surgical explantation of the device.(1) As technology has provided a clear benefit for the field , there continues to remain the elusive goal of optimal patient selection. The causes of explantation have ranged from biologic complications, hardware complications, the need for complex MRI scans , mental health reasons , loss of efficacy, complications, the need for complex MRI scans, mental health issues prior to spinal cord stimulator (SCS) trials.(2,3) It is this last reason , the lack of efficacy due to patient factors which is lacking appropriate evidence. (4) We hypothesized that in our VA population, many of which have been implanted elsewhere, explants may be related to lack of screening for symptoms and/or radiographic evidence of spinal stenosis prior to SCS trial and implant. Given the surgical risk and expense we wanted to use the best evidence to select Veteran patients who would benefit from SCS technology.
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