Introduction

Spinal cord stimulators (SCS) implanted using paraesthesia mapping and anatomical placement are widely used in the UK. The National Institute of Clinical Excellence and Heath recommends the use of anatomically placed, non paraesthetic SCS for providing pain relief with shorter and predictable operating time. The purpose of the review was to assess this, with a view of optimising theatre efficiency.

The aim of this review is to assess if anatomical placement (AP) of SCS offers shorter and more predictable operating times compared to paraesthesia mapping (PM).

Methods/Materials

All SCS implanted (both trial and permanent) at Leeds Teaching Hospitals between January 2018 and January 2020 were included in the review. Implants completed by operators that had done less than 10 cases in the study period were excluded. The time taken for each operator to implant a trial or full SCS using paraesthesia mapping (PM) and anatomical placement (AP) were then analysed.

Results

A total of 440 cases met the inclusion criteria. PM accounted for 194 cases and AP accounted for 246 cases, spread across four operators. The breakdown of the time taken from incision to closure per operator is summarised below:

Operators performed AP SCS implants (trial and full) quicker than PM SCS (p=0.041) but there was no statistical significant difference in predictability (p=0.08).

Discussion

Different operators work at different speeds so the same number of patients cannot be booked on each operating list. Theatre efficiency is also affected by anaesthetic time and theatre turn over time. Although AP SCS implantation was quicker, the variability in times from incision to closure for AP SCS and PM SCS were similar. Thus, theatre sessions can be planned efficiently for both AP and PM SCS.

Conclusions

This single centre analysis shows that anatomical placement of SCS offers shorter procedural time as suggested by NICE MTG41 but the predictability of procedural times is similar to paraesthesia mapping.