Paddle Lead Spinal Cord Stimulation for Chronic Pain in Octogenarians: A Case Series.

Abstract

Spinal cord stimulation (SCS) is a surgical technique for chronic pain involving the placement of percutaneous, or paddle leads into the spinal epidural for pain treatment. Paddle lead SCS is a more invasive procedure due to the requirement of bone removal (laminotomy/laminectomy) and may therefore be less commonly offered to older patients. A retrospective review was conducted of a database of all paddle lead spinal cord stimulators implanted from January 1st, 2019, to July 1st, 2024, by a single surgeon. Octogenarian patients were identified within this cohort and their data analyzed, including demographics and treatment history. Postoperative pain was subjectively measured during follow-up visits. Descriptive statistics were compiled, and a one-way analysis of variance test was used to measure the mean postoperative pain levels. Fifty-one patients were included in our cohort with a median age of 83 (interquartile range 81-85). Over one-half (n = 27, 53%) of patients had concurrent back and leg pain. There was no statistically significant differences in regard to location of presenting pain and improvement of pain. Moreover, there was no statistically significant difference in trial improvement with postoperative pain outcomes in our cohort. Two (4%) patients suffered postoperative infections, and two (4%) had device removal. There were no neurologic deficits nor mortality. Paddle lead SCS may be performed safely in octogenarians with no obvious increase in complications or less efficacy and should not be precluded in these patients with chronic pain and may have a favorable risk/benefit profile compared to more invasive spinal surgeries.