• Alan H Daniels, Wesley M Durand, Alyssa J Steinbaum, Renaud Lafage, D Kojo Hamilton, Peter G Passias, Han Jo Kim, Themistocles Protopsaltis, Virginie Lafage, Justin S Smith, Christopher Shaffrey, Munish Gupta, Eric O Klineberg, Frank Schwab, Jeffrey L Gum, Gregory Mundis, Robert Eastlack, Khaled Kebaish, Alex Soroceanu, Richard A Hostin, Doug Burton, Shay Bess, Christopher Ames, Robert A Hart, and ISSG.
• Department of Orthopedics, Warren Alpert Medical School, Brown University, Providence, RI.
• Spine. 2022 Feb 1; 47 (3): 227233227-233.

Study DesignRetrospective cohort study of a prospectively collected multi-center database of adult spinal deformity (ASD) patients.ObjectiveWe hypothesized that patients undergoing ASD surgery with and without previous spinal cord stimulators (SCS)/ intrathecal medication pumps (ITP) would exhibit increased complication rates but comparable improvement in health-related quality of life.Summary Of Background DataASD patients sometimes seek pain management with SCS or ITP before spinal deformity correction. Few studies have examined outcomes in this patient population.MethodsPatients undergoing ASD surgery and eligible for 2-year follow-up were included. Preoperative radiographs were reviewed for the presence of SCS/ITP. Outcomes included complications, Oswestry Disability Index (ODI), Short Form-36 Mental Component Score, and SRS-22r. Propensity score matching was utilized.ResultsIn total, of 1034 eligible ASD patients, a propensity score-matched cohort of 60 patients (30 with SCS/ITP, 30 controls) was developed. SCS/ITP were removed intraoperatively in most patients (56.7%, n = 17). The overall complication rate was 80.0% versus 76.7% for SCS/ITP versus control (P > 0.2), with similarly nonsignificant differences for intraoperative and infection complications (all P > 0.2). ODI was significantly higher among patients with SCS/ITP at baseline (59.2 vs. 47.6, P = 0.0057) and at 2-year follow-up (44.4 vs. 27.7, P = 0.0295). The magnitude of improvement, however, did not significantly differ (P = 0.45). Similar results were observed for SRS-22r pain domain. Satisfaction did not differ between groups at either baseline or follow-up (P > 0.2). No significant difference was observed in the proportion of patients with SCS/ITP versus control reaching minimal clinically important difference in ODI (47.6% vs. 60.9%, P = 0.38). Narcotic usage was more common among patients with SCS/ITP at both baseline and follow-up (P < 0.05).ConclusionASD patients undergoing surgery with SCS/ITP exhibited worse preoperative and postoperative ODI and SRS-22r pain domain; however, the mean improvement in outcome scores was not significantly different from patients without stimulators or pumps. No significant differences in complications were observed between patients with versus without SCS/ITP.Level of Evidence: 3.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

9 keywords...

hide…