Complications leading to device explant in patients with chronic non-cancer pain receiving intrathecal drug delivery.

Abstract

Intrathecal drug delivery (IDD) is often used in the management of refractory chronic non-cancer pain, particularly persistent chronic low back pain in the setting of previous lumbar spine surgery (persistent spinal pain syndrome type 2 (PSPS2)). Complications of IDD leading to device explant in patients with chronic non-cancer pain have not been well characterized. This study evaluated complications leading to device explants in a large cohort of patients with chronic non-cancer pain treated with IDD. A retrospective study was undertaken on patients with chronic non-cancer pain who underwent device implants by Pain Medicine physicians between June 2009 and December 2022 at a large tertiary center academic practice. Data collection included demographic and comorbidity data as well as the various indications for device explant. Data were collected from 215 patients with chronic non-cancer pain who underwent device implant and were followed for a mean duration of 80±48.8 months. The average age at the time of implant was 63.24±12.05 years, and the majority (184 patients) suffered from PSPS2. The explant rate was 26.1%, and device-related infection was the leading cause of explants occurring in 9.3% of patients and 5.9% of device surgeries. Loss of analgesic efficacy leading to device explant occurred in 5.6% of patients, but this was significantly less than the explant rate due to habituation noted with spinal cord stimulation (SCS) in a similar patient population. compared with other complications leading to device explants, infections had a much earlier time interval from device implant to explant. No demographic or comorbidity factors correlated with device explants. Device-related infections are the leading cause for explants in IDD for chronic non-cancer pain. Explants due to loss of analgesic efficacy occurred at a lesser frequency with IDD compared with SCS explants in a similar patient population.