Examination of Adult Spinal Deformity Patients Undergoing Surgery with Implanted Spinal Cord Stimulators and Intrathecal Pumps.

dc.contributor.author

Daniels, Alan H

dc.contributor.author

Durand, Wesley M

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Steinbaum, Alyssa J

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Lafage, Renaud

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Hamilton, D Kojo

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Passias, Peter G

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Kim, Han Jo

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Protopsaltis, Themistocles

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Lafage, Virginie

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Smith, Justin S

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Shaffrey, Christopher

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Gupta, Munish

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Klineberg, Eric O

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Schwab, Frank

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Gum, Jeffrey L

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Mundis, Gregory

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Eastlack, Robert

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Kebaish, Khaled

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Soroceanu, Alex

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Hostin, Richard A

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Burton, Doug

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Bess, Shay

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Ames, Christopher

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Hart, Robert A

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ISSG

dc.date.accessioned

2023-06-16T15:16:26Z

dc.date.available

2023-06-16T15:16:26Z

dc.date.issued

2022-02

dc.date.updated

2023-06-16T15:16:25Z

dc.description.abstract

Study design

Retrospective cohort study of a prospectively collected multi-center database of adult spinal deformity (ASD) patients.

Objective

We 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 data

ASD patients sometimes seek pain management with SCS or ITP before spinal deformity correction. Few studies have examined outcomes in this patient population.

Methods

Patients 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.

Results

In 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).

Conclusion

ASD 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.
dc.identifier

00007632-900000000-93631

dc.identifier.issn

0362-2436

dc.identifier.issn

1528-1159

dc.identifier.uri

https://hdl.handle.net/10161/28046

dc.language

eng

dc.publisher

Ovid Technologies (Wolters Kluwer Health)

dc.relation.ispartof

Spine

dc.relation.isversionof

10.1097/brs.0000000000004176

dc.subject

ISSG

dc.subject

Spinal Cord

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Humans

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Scoliosis

dc.subject

Pain

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Treatment Outcome

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Postoperative Period

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Retrospective Studies

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Quality of Life

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Adult

dc.title

Examination of Adult Spinal Deformity Patients Undergoing Surgery with Implanted Spinal Cord Stimulators and Intrathecal Pumps.

dc.type

Journal article

duke.contributor.orcid

Shaffrey, Christopher|0000-0001-9760-8386

pubs.begin-page

227

pubs.end-page

233

pubs.issue

3

pubs.organisational-group

Duke

pubs.organisational-group

School of Medicine

pubs.organisational-group

Clinical Science Departments

pubs.organisational-group

Orthopaedic Surgery

pubs.organisational-group

Neurosurgery

pubs.publication-status

Published

pubs.volume

47

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