Paddle Lead Spinal Cord Stimulation in the Morbidly Obese Patient Population: Outcomes and Complications in a Single-Surgeon Cohort

Abstract

Paddle lead spinal cord stimulation (SCS) is used to treat refractory chronic pain. Morbidly-obese patients seek SCS to reduce chronic pain. However, these patients face worse surgical outcomes, and the SCS literature has not evaluated safety and efficacy in this patient population. This study is the largest single-surgeon case series to date on morbidly obese patients with paddle lead SCS implantations. The primary objective is to report post-operative complication rates in morbidly-obese patients receiving SCS implants. The secondary objective is to report patient-reported pain scores and PROMIS Pain Interference and Physical Function scores in these patients. A retrospective chart review was conducted. The patient charts were reviewed from the day of procedure consent to 6 months post-op. Demographic information, pain scores, PROMIS scores, neurological complications, infections, and wound complications were documented. 67 patients were included. The mean pre-operative BMI was 44.47±4.02 kg/m2. The mean age was 58.9±11.4 years old. There were no neurological complications. 3/67 (4%) developed culture-positive infections. 9/67 (13%) patients developed superficial wound dehiscence without underlying infection. The mean post-op PROMIS PF score was 31.6±6.2 (n=16) and the mean post-op PROMIS PI score was 64.0±6.4 (n=16). There was a reduction in pain scores, from 7.9±1.7 pre-op to 5.7±2.5 post-op (n=22, p=0.004). Paddle lead SCS implantation is safe for morbidly-obese patients. The only minimal-risk complications present were post-operative infections and wound dehiscence. Surgical care can be modified to further reduce the rates of infection and dehiscence.