Journal article
Evaluation of Sagittal Spinopelvic Balance in Spinal Cord Stimulator Patients
Neuromodulation (Malden, Mass.), Vol.25(5), pp.775-782
06/09/2021
DOI: 10.1111/ner.13481
PMCID: PMC8655314
PMID: 35803682
Abstract
Objective
Spinal cord stimulation (SCS) has become a popular nonopioid pain intervention. However, the treatment failure rate for SCS remains significantly high and many of these patients have poor sagittal spinopelvic balance, which has been found to correlate with increased pain and decreased quality of life. The purpose of this study was to determine if poor sagittal alignment is correlated with SCS treatment failure.
Materials and Methods
Comparative retrospective analysis was performed between two cohorts of patients who had undergone SCS placement, those who had either subsequent removal of their SCS system (representing a treatment failure cohort) and those that underwent generator replacement (representing a successful treatment cohort). The electronic medical record was used to collect demographic and surgical characteristics, which included radiographic measurements of lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Also included were data on pain medication usage including opioid and nonopioid therapies.
Results
Eighty-one patients met inclusion criteria, 31 had complete removal, and 50 had generator replacements. Measurement of sagittal balance parameters demonstrated that many patients had poor alignment, with 34 outside normal range for LL (10 vs. 24 in removal and replacement cohorts, respectively), 30 for PI (12 [38.7%] vs. 18 [36.0%]), 46 for PT (18 [58.1%] vs. 28 [56.0%]), 38 for SS (18 [58.1%] vs. 20 [40.0%]), and 39 for PI-LL mismatch (14 [45.2%] vs. 25 [50.0%]). There were no significant differences in sagittal alignment parameters between the two cohorts.
Conclusions
This retrospective cohort analysis of SCS patients did not demonstrate any relationship between poor sagittal alignment and failure of SCS therapy. Further studies of larger databases should be performed to determine how many patients ultimately go on to have additional structural spinal surgery after failure of SCS and whether or not those patients go on to have positive outcomes.
Details
- Title: Subtitle
- Evaluation of Sagittal Spinopelvic Balance in Spinal Cord Stimulator Patients
- Creators
- Royce W Woodroffe - Department of Neurosurgery University of Iowa Carver College of Medicine Iowa City IA USAEli A Perez - Department of Neurosurgery University of Iowa Carver College of Medicine Iowa City IA USAScott C Seaman - Department of Neurosurgery University of Iowa Carver College of Medicine Iowa City IA USABrian J Park - Department of Neurosurgery University of Iowa Carver College of Medicine Iowa City IA USARuss P Nockels - Department of Neurosurgery Loyola University Medical Center Maywood IL USAMatthew A Howard - Department of Neurosurgery University of Iowa Carver College of Medicine Iowa City IA USASaul Wilson - Department of Neurosurgery University of Iowa Carver College of Medicine Iowa City IA USA
- Resource Type
- Journal article
- Publication Details
- Neuromodulation (Malden, Mass.), Vol.25(5), pp.775-782
- DOI
- 10.1111/ner.13481
- PMID
- 35803682
- PMCID
- PMC8655314
- NLM abbreviation
- Neuromodulation
- ISSN
- 1094-7159
- eISSN
- 1525-1403
- Grant note
- DOI: 10.13039/100000002, name: National Institutes of Health; DOI: 10.13039/100000050, name: National Heart, Lung, and Blood Institute
- Language
- English
- Electronic publication date
- 06/09/2021
- Academic Unit
- Neurology; Iowa Neuroscience Institute; Neurosurgery; Otolaryngology
- Record Identifier
- 9984087708502771
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