Comparison Between Surgical and Percutaneous Paddles in Spinal Cord Stimulation for Chronic Neuropathic Pain

TL;DR

This study compares surgical and percutaneous leads used in spinal cord stimulation for chronic pain, finding similar pain control but higher migration rates in percutaneous leads.

Contribution

The study provides a comparative analysis of surgical and percutaneous leads in spinal cord stimulation for chronic neuropathic pain using a long-term observational dataset.

Findings

No significant differences in pain control between surgical and percutaneous leads.

Percutaneous leads showed a higher lead migration rate.

Switching from percutaneous to surgical leads showed better pain relief in some patients.

Abstract

Background: Spinal cord stimulation (SCS) is a well-established treatment for chronic neuropathic pain, offering a safe procedure with low complication rates. Both surgical and percutaneous leads can be effective, with similar complication rates. Methods: We analyzed all patients implanted at a reference center since 1996 to compare pain control and complications and determine whether one system was more effective than the other in patients who had experienced both systems. A retrospective observational study was designed. Results: A total of 188 SCS systems were implanted, with a follow-up period of 79.71 ± 60.39 months (mean ± SD). We analyzed data from 106 males (56.38%) and 82 females (43.62%), ranging from 15 to 76 years old. A total of 68 (36.17%) surgical leads and 120 (63.83%) percutaneous leads were implanted for failed back syndrome (120, 63.83%), complex regional pain syndrome (56, 29.79%), and other conditions (12, 6.38%). No statistically significant differences were found in any variables except for lead migration (p = 0.05). In patients who initially had a percutaneous system and later received a surgical system, we found a statistically significant difference in pain relief percentage (p = 0.03) and a trend toward statistical significance in the PGI-C score (p = 0.08). Conclusions: Both surgical and percutaneous leads have demonstrated similar pain control rates, but percutaneous leads have a higher migration rate. Complications can be minimized by performing the procedure in specialized centers with extensive experience. Further studies comparing both systems should be conducted to determine if one type of lead is superior.

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