Battery Life of Pulse Generators in Spinal Cord Stimulation: Analysis and Comparison Between Surgical and Percutaneous Leads in Energy Efficiency

Background: Spinal cord stimulation (SCS) is an established therapy for chronic neuropathic pain. Although rechargeable and non-rechargeable pulse generators (PGs) are widely used, their real-world battery life and the influence of lead type on energy efficiency remain underexplored. Objective: To evaluate PG battery longevity and compare the performance of surgical versus percutaneous leads in terms of energy efficiency. Methods: We conducted a retrospective study of 283 PGs implanted at Hospital Virgen de las Nieves (Granada, Spain) from 1996 to 2023. Data on patient demographics, pain etiology, lead type and placement, stimulation modality, and PG status were extracted. A competing risks analysis was used to assess PG shutdown and early explantation over time. Results: Of the PGs analyzed, 43.5% were non-rechargeable and 56.5% rechargeable. Rechargeable PGs showed significantly longer battery life (mean: 82.7 vs. 38.9 months, p < 0.05), with a lower probability of shutdown at 50, 100, and 150 months. No significant differences in battery longevity were observed regarding lead location, stimulation type, or pain etiology. A trend toward longer battery life was observed with percutaneous leads, although not statistically significant. Conclusions: Rechargeable PGs demonstrated superior longevity compared to non-rechargeable models and should be considered the preferred option in most cases. While both surgical and percutaneous leads are effective, percutaneous systems may offer improved battery efficiency. Further prospective studies are warranted to confirm these findings and assess cost-effectiveness.