DeTemple, Nathan

Abstract Objectives Lumbar spine surgery is a common procedure for treating disabling spine‐related pain. In recent decades, both the number and cost of spine surgeries have increased despite technological advances and modification in surgical technique. For those patients that have continued uncontrolled back and/or lower extremity pain following lumbar spine surgery, spinal cord stimulation (SCS) has emerged as a viable treatment option. However, the impact of lumbar spine surgical history remains largely unstudied. Specifically, the current study considers the impact of number of prior lumbar spine surgeries on pain relief outcomes following SCS implantation. Materials and Methods We queried the electronic medical record of five separate pain practices for all patients who have undergone a SCS implant between January 1, 2017, and March 1, 2020. Inclusion criteria consisted of any patients with an SCS implant who underwent a prior lumbar spine surgery. The primary outcome was the mean calculated percentage pain relief in patients based on number of prior lumbar spine surgeries. Results There was a total of 1974 total SCS implant cases identified across five separate pain clinics. There was no difference in mean calculated pain relief in patients with one prior spine surgery versus those with two or more prior spine surgeries (28.2% vs. 25.8%, adjusted β‐coefficient –3.1, 95% CI –8.9 to 2.7, p = 0.290). Similarly, when analyzing number of spine surgeries as a continuous variable, there was no association between number of spine surgeries and calculated pain relief (adjusted β‐coefficient –1.5, 95% CI –4.0 to 1.1, p = 0.257). Additionally, after patients were stratified based on waveform, there was no association between number of prior lumbar spine surgeries (analyzed both as a categorical and continuous variable) and calculated percentage pain relief. Conclusions This multicentered retrospective study found that there was no significant difference in pain scores in individuals who received SCS following one or more lumbar spine surgeries. Additionally, the waveform of the SCS device had no statistically significant impact on post‐operative pain scores following one or more lumbar spine surgeries.

Abstract Introduction Lumbar spinal stenosis affects more than 200,000 adults in the United States, resulting in approximately 38,000 operations among the Medicare population and greater than $1.5 billion in hospital bills alone. Fortunately, Minimally Invasive Lumbar Decompression (MILD) and the Superion Indirect Decompression System have shown lasting benefit and cost savings compared to more aggressive surgical options. Objective Our primary objective was to retrospectively determine the rate of lumbar decompression surgery following the MILD and Superion procedures. Materials and Methods This was a pooled retrospective review of LSS patients who received MILD and/or Superion procedures between January 2011 and July 2019. Adult patients with CPT codes for MILD and Superion procedures were identified. Patients were included if they had a follow‐up visit at least 2 years from the procedure date, preprocedural MRI results, and surgical notes. Results A total of 199 patients were included in the final analysis, of which 57 patients (28.6%) underwent MILD procedure only, 124 patients (62.3%) underwent Superion only, and 18 patients (9.0%) underwent an MILD procedure initially followed by a Superion procedure. Two patients had an MILD procedure performed twice at the same level at separate encounters. A total of four patients in the entire cohort (2.0%; MILD 5.3%, Superion 0.8%) underwent subsequent lumbar spine surgery when followed for at least 2 years. It is notable that some of these patients may not have been surgical candidates and this may have skewed the results. Conclusions Patients undergoing minimally invasive decompression treatment of lumbar spinal stenosis have low rates of subsequent open surgery which potentially results in cost savings and a reduction in severe adverse events. The reason for low surgical rate may reflect improvement in their symptoms, a preference to avoid surgery, or being deemed not a surgical candidate.