Spinal cord stimulation (SCS) is widely used for post-laminectomy syndrome (PLS), also referred to as failed back surgery syndrome (FBSS). However, comparative safety and utilization outcomes across perioperative and longer-term horizons remain incompletely defined. We performed a retrospective matched cohort analysis using a large multi-institutional network. Adults with PLS were assigned to SCS or non-SCS cohorts. Following 1:1 propensity score matching, 2,853 patients remained in each cohort. Prespecified outcomes were evaluated at two and five years. Effect estimates were reported as odds ratios (ORs) with 95% confidence intervals (CIs). At two years, SCS was associated with lower pressure ulcer formation (3.87% vs 7.77%; OR 0.48, 95% CI 0.37–0.61; p < 0.0001), venous thromboembolism (VTE) (2.66% vs 4.03%; OR 0.65, 95% CI 0.49–0.88; p = 0.004), depression or anxiety (10.57% vs 15.41%; OR 0.65, 95% CI 0.53–0.79; p < 0.0001), antidepressant use (16.78% vs 25.66%; OR 0.58, 95% CI 0.50–0.68; p < 0.0001), opioid abuse (4.63% vs 6.13%; OR 0.74, 95% CI 0.59–0.94; p = 0.012), and interventional pain procedures (6.34% vs 8.56%; OR 0.72, 95% CI 0.58–0.90; p = 0.004). Stroke incidence was lower with SCS at two years (1.01% vs 1.72%; OR 0.58, 95% CI 0.36–0.93; p = 0.021), while emergency department (ED) admission rates did not differ (12.50% vs 12.16%; p = 0.73). Device-related reoperation was more frequent in the SCS cohort. Mortality was lower with SCS at two years (2.28% vs 3.40%; OR 0.66, 95% CI 0.48–0.91; p = 0.011). At five years, SCS remained associated with lower pressure ulcers (4.47% vs 10.33%; OR 0.42, 95% CI 0.34–0.80; p < 0.0001), VTE (3.44% vs 4.66%; OR 0.73, 95% CI 0.56–0.95; p = 0.019), depression or anxiety (17.16% vs 22.42%; OR 0.72, 95% CI 0.61–0.85; p < 0.0001), antidepressant use (10.48% vs 14.58%; OR 0.69, 95% CI 0.59–0.80; p < 0.0001), opioid abuse (7.47% vs 12.53%; OR 0.56, 95% CI 0.47–0.68; p < 0.0001), and ED admission rates (24.33% vs 28.92%; OR 0.79, 95% CI 0.70–0.89; p < 0.0001). Stroke rates were not significantly different at five years (2.26% vs 2.72%; OR 0.83, 95% CI 0.59–1.16; p = 0.27). Device-related reoperation remained substantially more common among SCS-treated patients. Mortality remained lower with SCS at five years (4.03% vs 6.03%; OR 0.66, 95% CI 0.51–0.83; p = 0.0006). In real-world practice, SCS for post-laminectomy syndrome was associated with lower risks of several systemic and neuropsychiatric complications and reduced longer-term healthcare utilization, but substantially greater procedural utilization due to device-related reoperations. Stroke risk differed by time horizon and was not significantly different at five years. Mortality was lower among SCS-treated patients at both two and five years. These findings support shared decision making that emphasizes benefits, trade-offs, peri-implant infection prevention strategies, psychological screening, and careful vascular risk management.
Wahid et al. (Wed,) studied this question.