Stim Salvage: Case Series Reporting on the Effectiveness of Spinal Cord Stimulation Salvage

Abstract

Abstract INTRODUCTION Spinal cord stimulation (SCS) has been successfully used to treat chronic pain with improved levels of pain, decreased use of narcotic medications, and increased level of function. Nevertheless, for patients SCS benefit wares over time and maximal reprogramming may not achieve improvement. However, advancing technologies, such as burst and high-frequency modulation, offer stimulation which differs from the traditional low-frequency stimulation. For those with SCS already placed, these new technologies offer a possible avenue with which to salvage SCS loss of efficacy. In patients with the an ineffective system, a salvage trial with a new system can be performed. In these cases, their current generators are externalized and then, utilizing their current epidural array, the leads are connected to a new trial system. These patients return to the OR in about 1 wk time for either permanent implantation or removal of the remainder of their old system. The results of these salvage trials are presented. METHODS We reviewed serially treated patients with previously placed SCS who were taken to the operating room for a salvage trial. All patient had their SCS leads externalized and connected to a different system. Changes in VAS, functional status, the trial outcomes led to permanent placement were collected retrospectively. RESULTS Results of 15 patient who underwent SCS externalization trial between 2016 and 2019 are summarized. Trial failure rate, salvage SCS response rate, changes in VAS, and patient satisfaction with the new system are reviewed. Successful salvage was accomplished in 93%. CONCLUSION New stimulation paradigms such as burst and high frequency offer a new avenue of effective treatment for those with an ineffective SCS systems. When a patient's device is unable to deliver these paradigms, an IPG-externalization trial may be a low risk option for salvaging therapy.