EPV015 - EXPLANT DATA ON 1177 PATIENTS IN A SINGLE CENTRE SPECIALISING IN NEUROMODULATION OVER AN 11 YEAR PERIOD (ID 237)
- Adnan Al-Kaisy, United Kingdom
- Adnan Al-Kaisy, United Kingdom
- Jonathan Royds, United Kingdom
- Omar Al-Kaisy, United Kingdom
- Samuel Wesley, United Kingdom
- Stefano Palmisani, United Kingdom
- David Pang, United Kingdom
- Stephany Harris, United Kingdom
- Thomas Yearwood, United Kingdom
- Stephen Ward, United Kingdom
Abstract
Introduction
The publication of explant rates has established risk factors and a definitive outcome of failure for Spinal Cord Stimulation (SCS) for neuropathic pain. Success of SCS is gauged subjectively and there is currently a paucity of long term efficacy data in the scientific literature. Explant rates due to a loss of perceived benefit however are a definitive objective outcome of failure. We present a UK study of explants of neuromodulatory devices for different neuropathic pain conditions over an 11-year period in a single centre specialising in Neuromodulation.
Methods/Materials
A retrospective analysis was performed using a departmental database between 2008-2019. Aetiology of pain, leads, device, sex, age, psychological assessment and reason for explant were recorded. Indications for implant included: Failed back or neck surgery syndrome, Back with or without radicular pain with no prior surgery, CRPS, Head pain, Neurogenic Bladder, Pelvic pain, Abdominal/Loin pain and Neuropathic pain. Reasons for explant included: loss of efficacy, infection, resolution of pain, requiring MRI, device related complications and other reasons. Explants were analysed according to condition, mode of stimulation and other demographics using logistic regression and survival curves with a Log-rank (Mantel-Cox) test.
Results
1177 patients were implanted between April 2008-December 2018. Most of the explants were performed within the first 5 years (21.9% year 0-5 vs. 4.5% year 5-11). The overall explant rate was 17.8% at 5 years and 25.2% at 10 years. The most common indication for explant was due to loss of efficacy and was 13.1 % at 5 years and 17.5% at 10 years. Head pain had the highest explant rate due to loss of efficacy at 5 years (25.4%). There was a non-significant trend to greater risk of explant for non-research patients in comparison to research patients(p=0.068). There was no significant difference in the rate of explant between the different conditions(p=0.47), age(p=0.77), sex(p=0.75), waveform(p=0.16) and battery type(p=0.53).
Discussion
Explant rates in patients selected for neuromodulation give a long-term reliable objective outcome of failure. An acceptable explant rate has yet to be defined but the publication of further data sets will contribute to this in the future.
Conclusions
Research based patients likely have less risk of explant compared to non-research patients indicating selection criteria is key for SCS. Although not significant head pain may have potentially higher risk of explants; this may be related to not trialing prior to full implant. Although previously reported battery type and gender demonstrated no difference in explant rates.
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