New paper: Long Term Pain Reduction and Explantation Rates of SCS
Matthew Saw, Revekka Agababaeva, Mohammad A. Sabri, Marc Russo, Corey Hunter, Sayed Wahezi, Lawrence Poree, Marom Bikson,
Long Term Pain Reduction and Explantation Rates of Spinal Cord Stimulation: A Systematic Review and Meta-Analysis
Neuromodulation: Technology at the Neural Interface, 2026, https://www.sciencedirect.com/science/article/pii/S1094715926013061
Spinal Cord Stimulation (SCS) is a therapeutic option for chronic pain conditions such as Persistent Spinal Pain Syndrome (PSPS), Complex Regional Pain Syndrome (CRPS), Painful Diabetic Peripheral Neuropathy (PDPN), and radiculopathy. Treatment typically involves a temporary trial phase prior to permanent implantation. Despite demonstrated efficacy, trial phase failure and long-term SCS outcomes remain important considerations. The aim of this review is to quantify three key SCS outcomes: (1) trial phase nonresponse, (2) annual explantation rates after permanent implantation up to three years, and (3) annual <50% pain reduction rates among patients who retain their implant up to three years.
Materials and Methods
A systematic literature review was conducted across PubMed, Embase, and Cochrane databases to identify studies reporting on SCS outcomes. Studies were included if they reported quantitative data on at least one of the three outcomes. Data was extracted and summarized across studies. A three-level binomial generalized linear mixed model with logit link was used to calculate pooled rates across included studies. Risk of bias was assessed using the RoB 2 tool and NIH quality assessment tools as appropriate, and certainty of evidence was evaluated using the GRADE framework.
Results
38 studies were included in the analysis. The pooled trial phase failure rate was 16.2%. Pooled explant rates were 4.0%, 7.0%, and 11.9% at one, two, and three years respectively. Pooled rates of <50% pain reduction were 24.2%, 27.0%, and 32.8% at one, two, and three years respectively.
Conclusion
We aggregate and analyze durability of SCS outcomes according to a defined rubric. Outcomes were not stratified by factors that could influence response, such as waveform. 16.2% of patients assessed for SCS eligibility did not proceed past the trial phase. On average, at three years post-implantation, 44.7% of patients with permanent implants had undergone explantation or reported less than 50% pain relief.
Keywords: Spinal Cord Stimulation (SCS); chronic pain; neuropathic pain; explants; outcomes; neuromodulation