{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T02:44:30Z","timestamp":1783651470380,"version":"3.55.0"},"reference-count":72,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2015,10]]},"abstract":"\n OBJECT<\/jats:title>\n Structural spinal surgery yields improvement in pain and disability for selected patients with spinal stenosis, spondylolisthesis, or a herniated intervertebral disc. A significant fraction of patients exhibit persistent postoperative neuropathic pain (PPNP) despite technically appropriate intervention, and such patients can benefit from spinal cord stimulation (SCS) to alleviate suffering. The complication profile of this therapy has not been systematically assessed and, thus, was the goal of this review.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n A comprehensive literature search was performed to identify prospective cohorts of patients who had PPNP following structurally corrective lumbar spinal surgery and who underwent SCS device implantation. Data about study design, technique of SCS lead introduction, and complications encountered were collected and analyzed. Comparisons of complication incidence were performed between percutaneously and surgically implanted systems, with the level of significance set at 0.05.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Review of 11 studies involving 542 patients formed the basis of this work: 2 randomized controlled trials and 9 prospective cohorts. Percutaneous implants were used in 4 studies and surgical implants were used in 4 studies; in the remainder, the types were undefined. Lead migration occurred in 12% of cases, pain at the site of the implantable pulse generator occurred in 9% of cases, and wound-related complications occurred in 5% of cases; the latter 2 occurred more frequently among surgically implanted devices.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Spinal cord stimulation can provide for improved pain and suffering and for decreased narcotic medication use among patients with PPNP after lumbar spinal surgery. This study reviewed the prospective studies forming the evidence base for this therapy, to summarize the complications encountered and, thus, best inform patients and clinicians considering its use. There is a significant rate of minor complications, many of which require further surgical intervention to manage, including lead migration or implant infection, although such complications do not directly threaten patient life or function.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2015.7.focus15260","type":"journal-article","created":{"date-parts":[[2015,10,1]],"date-time":"2015-10-01T03:41:45Z","timestamp":1443670905000},"page":"E15","source":"Crossref","is-referenced-by-count":51,"title":["Complications related to the use of spinal cord stimulation for managing persistent postoperative neuropathic pain after lumbar spinal surgery"],"prefix":"10.3171","volume":"39","author":[{"given":"Mohammed F.","family":"Shamji","sequence":"first","affiliation":[{"name":"Department of Surgery, University of Toronto;"},{"name":"Division of Neurosurgery, Toronto Western Hospital., Toronto, Ontario;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harrison J.","family":"Westwick","sequence":"additional","affiliation":[{"name":"Department of Surgery, Universit\u00e9 de Montr\u00e9al., Quebec, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert F.","family":"Heary","sequence":"additional","affiliation":[{"name":"Rutgers New Jersey Medical School, Newark, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus15260","series-title":"Pain Med","first-page":"347","article-title":"Sustained effectiveness of 10 kHz high-frequency spinal cord stimulation for patients with chronic, low back pain: 24-month results of a prospective multicenter study","volume":"15","author":"Al-Kaisy","year":"2014"},{"key":"b2-focus15260","series-title":"Neuromodulation","first-page":"177","article-title":"Intraoperative powdered vancomycin use with paddle lead placement","volume":"18","author":"Amrani","year":"2015"},{"key":"b3-focus15260","series-title":"Pain","first-page":"2426","article-title":"Spinal cord stimulation in patients with painful diabetic neuropathy: a multicentre randomized clinical trial","volume":"155","author":"de Vos","year":"2014"},{"key":"b4-focus15260","series-title":"Neuromodulation","first-page":"21","article-title":"The prospective evaluation of safety and success of a new method of introducing percutaneous paddle leads and complex arrays with an epidural access system","volume":"15","author":"Deer","year":"2012"},{"key":"b5-focus15260","series-title":"Neuromodulation","first-page":"113","article-title":"Spinal cord stimulation with a dual quadripolar surgical lead placed in general anesthesia is effective in treating intractable low back and leg pain","volume":"10","author":"Duyvendak","year":"2007"},{"key":"b6-focus15260","series-title":"Pain Physician","first-page":"379","article-title":"Spinal cord stimulation for patients with failed back surgery syndrome: a systematic review","volume":"12","author":"Frey","year":"2009"},{"key":"b7-focus15260","series-title":"Neuromodulation","first-page":"133","article-title":"A national survey of spinal cord stimulation trial-to-permanent conversion rates","volume":"18","author":"Huang","year":"2015"},{"key":"b8-focus15260","series-title":"Neuromodulation","first-page":"402","article-title":"Percutaneous implanted paddle lead for spinal cord stimulation: technical considerations and long-term follow-up","volume":"15","author":"Kinfe","year":"2012"},{"key":"b9-focus15260","series-title":"Pain Med","first-page":"1631","article-title":"Cost-effectiveness of spinal cord stimulation therapy in management of chronic pain","volume":"14","author":"Kumar","year":"2013"},{"key":"b10-focus15260","series-title":"Pain Pract","first-page":"709","article-title":"Impact of wait times on spinal cord stimulation therapy outcomes","volume":"14","author":"Kumar","year":"2014"},{"key":"b11-focus15260","series-title":"Neurosurgery","first-page":"762","article-title":"The effects of spinal cord stimulation in neuropathic pain are sustained: a 24-month follow-up of the prospective randomized controlled multicenter trial of the effectiveness of spinal cord stimulation","volume":"63","author":"Kumar","year":"2008"},{"key":"b12-focus15260","series-title":"Pain","first-page":"179","article-title":"Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomized controlled trial in patients with failed back surgery syndrome","volume":"132","author":"Kumar","year":"2007"},{"key":"b13-focus15260","series-title":"Neuromodulation","first-page":"412","article-title":"Incidence and avoidance of neurologic complications with paddle type spinal cord stimulation leads","volume":"14","author":"Levy","year":"2011"},{"key":"b14-focus15260","series-title":"Neuromodulation","first-page":"537","article-title":"Long-term outcomes of spinal cord stimulation with percutaneously introduced paddle leads in the treatment of failed back surgery syndrome and lumboischialgia","volume":"16","author":"Log\u00e9","year":"2013"},{"key":"b15-focus15260","series-title":"Pain Pract","first-page":"148","article-title":"Retrospective review of 707 cases of spinal cord stimulation: indications and complications","volume":"11","author":"Mekhail","year":"2011"},{"key":"b16-focus15260","series-title":"Neurol Res","first-page":"285","article-title":"Mechanisms of spinal cord stimulation in neuropathic pain","volume":"22","author":"Meyerson","year":"2000"},{"issue":"4 Suppl","key":"b17-focus15260","series-title":"J Pain Symptom Manage","first-page":"S6","article-title":"Mode of action of spinal cord stimulation in neuropathic pain","volume":"31","author":"Meyerson","year":"2006"},{"key":"b18-focus15260","series-title":"Neurosurgery","first-page":"361","article-title":"Spinal cord stimulation versus reoperation for failed back surgery syndrome: a cost effectiveness and cost utility analysis based on a randomized, controlled trial","volume":"61","author":"North","year":"2007"},{"key":"b19-focus15260","series-title":"Neurosurgery","first-page":"98","article-title":"Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial","volume":"56","author":"North","year":"2005"},{"key":"b20-focus15260","series-title":"Spine (Phila Pa 1976)","first-page":"1412","article-title":"Spinal cord stimulation for axial low back pain: a prospective, controlled trial comparing dual with single percutaneous electrodes","volume":"30","author":"North","year":"2005"},{"key":"b21-focus15260","series-title":"Neurosurgery","first-page":"990","article-title":"Spinal cord stimulation electrode design: a prospective, randomized, controlled trial comparing percutaneous with laminectomy electrodes: part II-clinical outcomes","volume":"57","author":"North","year":"2005"},{"key":"b22-focus15260","series-title":"Neuromodulation","first-page":"192","article-title":"Transverse tripolar spinal cord stimulation: results of an international multicenter study","volume":"9","author":"Oakley","year":"2006"},{"key":"b23-focus15260","series-title":"Spine (Phila Pa 1976)","first-page":"2574","article-title":"Spinal cord stimulation: mechanisms of action","volume":"27","author":"Oakley","year":"2002"},{"key":"b24-focus15260","series-title":"Pain Pract","first-page":"195","article-title":"An algorithmic programming approach for back pain symptoms in failed back surgery syndrome using spinal cord stimulation with a multicolumn surgically implanted epidural lead: a multicenter international prospective study","volume":"15","author":"Rigoard","year":"2015"},{"key":"b25-focus15260","series-title":"Neurosurgery","first-page":"550","article-title":"Multicolumn spinal cord stimulation lead implantation using an optic transligamentar minimally invasive technique","volume":"73","author":"Rigoard","year":"2013"},{"key":"b26-focus15260","series-title":"Pain Pract","first-page":"154","article-title":"Experimental spinal cord stimulation and neuropathic pain: mechanism of action, technical aspects, and effectiveness","volume":"13","author":"Smits","year":"2013"},{"issue":"4 Suppl","key":"b27-focus15260","series-title":"J Pain Symptom Manage","first-page":"S13","article-title":"Spinal cord stimulation in complex regional pain syndrome and refractory neuropathic back and leg pain\/failed back surgery syndrome: results of a systematic review and meta-analysis","volume":"31","author":"Taylor","year":"2006"},{"key":"b28-focus15260","series-title":"BMC Cardiovasc Disord","first-page":"13","article-title":"Spinal cord stimulation in the treatment of refractory angina: systematic review and meta-analysis of randomised controlled trials","volume":"9","author":"Taylor","year":"2009"},{"key":"b29-focus15260","series-title":"J Pain Symptom Manage","first-page":"370","article-title":"The cost effectiveness of spinal cord stimulation in the treatment of pain: a systematic review of the literature","volume":"27","author":"Taylor","year":"2004"},{"key":"b30-focus15260","series-title":"Pain","first-page":"14","article-title":"Spinal cord stimulation for failed back surgery syndrome: outcomes in a workers\u2019 compensation setting","volume":"148","author":"Turner","year":"2010"},{"key":"b31-focus15260","series-title":"Br J Surg","first-page":"948","article-title":"Systematic review and meta-analysis of controlled trials assessing spinal cord stimulation for inoperable critical leg ischaemia","volume":"91","author":"Ubbink","year":"2004"},{"key":"b32-focus15260","series-title":"Neuromodulation","first-page":"59","article-title":"High-frequency spinal cord stimulation for the treatment of chronic back pain patients: results of a prospective multicenter European clinical study","volume":"16","author":"Van Buyten","year":"2013"},{"key":"b33-focus15260","series-title":"Neurosurgery","first-page":"399","article-title":"Laminectomy versus percutaneous electrode placement for spinal cord stimulation","volume":"46","author":"Villavicencio","year":"2000"},{"key":"b34-focus15260","series-title":"Spine (Phila Pa 1976)","first-page":"2789","article-title":"Surgical versus nonoperative treatment for lumbar disc herniation: four-year results for the Spine Patient Outcomes Research Trial (SPORT)","volume":"33","author":"Weinstein","year":"2008"},{"key":"b35-focus15260","series-title":"J Bone Joint Surg Am","first-page":"1295","article-title":"Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts","volume":"91","author":"Weinstein","year":"2009"},{"key":"b36-focus15260","series-title":"Spine (Phila Pa 1976)","first-page":"1329","article-title":"Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial","volume":"35","author":"Weinstein","year":"2010"},{"key":"b1-focus15260","series-title":"Pain Med","first-page":"347","article-title":"Sustained effectiveness of 10 kHz high-frequency spinal cord stimulation for patients with chronic, low back pain: 24-month results of a prospective multicenter study","volume":"15","author":"Al-Kaisy","year":"2014"},{"key":"b2-focus15260","series-title":"Neuromodulation","first-page":"177","article-title":"Intraoperative powdered vancomycin use with paddle lead placement","volume":"18","author":"Amrani","year":"2015"},{"key":"b3-focus15260","series-title":"Pain","first-page":"2426","article-title":"Spinal cord stimulation in patients with painful diabetic neuropathy: a multicentre randomized clinical trial","volume":"155","author":"de Vos","year":"2014"},{"key":"b4-focus15260","series-title":"Neuromodulation","first-page":"21","article-title":"The prospective evaluation of safety and success of a new method of introducing percutaneous paddle leads and complex arrays with an epidural access system","volume":"15","author":"Deer","year":"2012"},{"key":"b5-focus15260","series-title":"Neuromodulation","first-page":"113","article-title":"Spinal cord stimulation with a dual quadripolar surgical lead placed in general anesthesia is effective in treating intractable low back and leg pain","volume":"10","author":"Duyvendak","year":"2007"},{"key":"b6-focus15260","series-title":"Pain Physician","first-page":"379","article-title":"Spinal cord stimulation for patients with failed back surgery syndrome: a systematic review","volume":"12","author":"Frey","year":"2009"},{"key":"b7-focus15260","series-title":"Neuromodulation","first-page":"133","article-title":"A national survey of spinal cord stimulation trial-to-permanent conversion rates","volume":"18","author":"Huang","year":"2015"},{"key":"b8-focus15260","series-title":"Neuromodulation","first-page":"402","article-title":"Percutaneous implanted paddle lead for spinal cord stimulation: technical considerations and long-term follow-up","volume":"15","author":"Kinfe","year":"2012"},{"key":"b9-focus15260","series-title":"Pain Med","first-page":"1631","article-title":"Cost-effectiveness of spinal cord stimulation therapy in management of chronic pain","volume":"14","author":"Kumar","year":"2013"},{"key":"b10-focus15260","series-title":"Pain Pract","first-page":"709","article-title":"Impact of wait times on spinal cord stimulation therapy outcomes","volume":"14","author":"Kumar","year":"2014"},{"key":"b11-focus15260","series-title":"Neurosurgery","first-page":"762","article-title":"The effects of spinal cord stimulation in neuropathic pain are sustained: a 24-month follow-up of the prospective randomized controlled multicenter trial of the effectiveness of spinal cord stimulation","volume":"63","author":"Kumar","year":"2008"},{"key":"b12-focus15260","series-title":"Pain","first-page":"179","article-title":"Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomized controlled trial in patients with failed back surgery syndrome","volume":"132","author":"Kumar","year":"2007"},{"key":"b13-focus15260","series-title":"Neuromodulation","first-page":"412","article-title":"Incidence and avoidance of neurologic complications with paddle type spinal cord stimulation leads","volume":"14","author":"Levy","year":"2011"},{"key":"b14-focus15260","series-title":"Neuromodulation","first-page":"537","article-title":"Long-term outcomes of spinal cord stimulation with percutaneously introduced paddle leads in the treatment of failed back surgery syndrome and lumboischialgia","volume":"16","author":"Log\u00e9","year":"2013"},{"key":"b15-focus15260","series-title":"Pain Pract","first-page":"148","article-title":"Retrospective review of 707 cases of spinal cord stimulation: indications and complications","volume":"11","author":"Mekhail","year":"2011"},{"key":"b16-focus15260","series-title":"Neurol Res","first-page":"285","article-title":"Mechanisms of spinal cord stimulation in neuropathic pain","volume":"22","author":"Meyerson","year":"2000"},{"issue":"4 Suppl","key":"b17-focus15260","series-title":"J Pain Symptom Manage","first-page":"S6","article-title":"Mode of action of spinal cord stimulation in neuropathic pain","volume":"31","author":"Meyerson","year":"2006"},{"key":"b18-focus15260","series-title":"Neurosurgery","first-page":"361","article-title":"Spinal cord stimulation versus reoperation for failed back surgery syndrome: a cost effectiveness and cost utility analysis based on a randomized, controlled trial","volume":"61","author":"North","year":"2007"},{"key":"b19-focus15260","series-title":"Neurosurgery","first-page":"98","article-title":"Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial","volume":"56","author":"North","year":"2005"},{"key":"b20-focus15260","series-title":"Spine (Phila Pa 1976)","first-page":"1412","article-title":"Spinal cord stimulation for axial low back pain: a prospective, controlled trial comparing dual with single percutaneous electrodes","volume":"30","author":"North","year":"2005"},{"key":"b21-focus15260","series-title":"Neurosurgery","first-page":"990","article-title":"Spinal cord stimulation electrode design: a prospective, randomized, controlled trial comparing percutaneous with laminectomy electrodes: part II-clinical outcomes","volume":"57","author":"North","year":"2005"},{"key":"b22-focus15260","series-title":"Neuromodulation","first-page":"192","article-title":"Transverse tripolar spinal cord stimulation: results of an international multicenter study","volume":"9","author":"Oakley","year":"2006"},{"key":"b23-focus15260","series-title":"Spine (Phila Pa 1976)","first-page":"2574","article-title":"Spinal cord stimulation: mechanisms of action","volume":"27","author":"Oakley","year":"2002"},{"key":"b24-focus15260","series-title":"Pain Pract","first-page":"195","article-title":"An algorithmic programming approach for back pain symptoms in failed back surgery syndrome using spinal cord stimulation with a multicolumn surgically implanted epidural lead: a multicenter international prospective study","volume":"15","author":"Rigoard","year":"2015"},{"key":"b25-focus15260","series-title":"Neurosurgery","first-page":"550","article-title":"Multicolumn spinal cord stimulation lead implantation using an optic transligamentar minimally invasive technique","volume":"73","author":"Rigoard","year":"2013"},{"key":"b26-focus15260","series-title":"Pain Pract","first-page":"154","article-title":"Experimental spinal cord stimulation and neuropathic pain: mechanism of action, technical aspects, and effectiveness","volume":"13","author":"Smits","year":"2013"},{"issue":"4 Suppl","key":"b27-focus15260","series-title":"J Pain Symptom Manage","first-page":"S13","article-title":"Spinal cord stimulation in complex regional pain syndrome and refractory neuropathic back and leg pain\/failed back surgery syndrome: results of a systematic review and meta-analysis","volume":"31","author":"Taylor","year":"2006"},{"key":"b28-focus15260","series-title":"BMC Cardiovasc Disord","first-page":"13","article-title":"Spinal cord stimulation in the treatment of refractory angina: systematic review and meta-analysis of randomised controlled trials","volume":"9","author":"Taylor","year":"2009"},{"key":"b29-focus15260","series-title":"J Pain Symptom Manage","first-page":"370","article-title":"The cost effectiveness of spinal cord stimulation in the treatment of pain: a systematic review of the literature","volume":"27","author":"Taylor","year":"2004"},{"key":"b30-focus15260","series-title":"Pain","first-page":"14","article-title":"Spinal cord stimulation for failed back surgery syndrome: outcomes in a workers\u2019 compensation setting","volume":"148","author":"Turner","year":"2010"},{"key":"b31-focus15260","series-title":"Br J Surg","first-page":"948","article-title":"Systematic review and meta-analysis of controlled trials assessing spinal cord stimulation for inoperable critical leg ischaemia","volume":"91","author":"Ubbink","year":"2004"},{"key":"b32-focus15260","series-title":"Neuromodulation","first-page":"59","article-title":"High-frequency spinal cord stimulation for the treatment of chronic back pain patients: results of a prospective multicenter European clinical study","volume":"16","author":"Van Buyten","year":"2013"},{"key":"b33-focus15260","series-title":"Neurosurgery","first-page":"399","article-title":"Laminectomy versus percutaneous electrode placement for spinal cord stimulation","volume":"46","author":"Villavicencio","year":"2000"},{"key":"b34-focus15260","series-title":"Spine (Phila Pa 1976)","first-page":"2789","article-title":"Surgical versus nonoperative treatment for lumbar disc herniation: four-year results for the Spine Patient Outcomes Research Trial (SPORT)","volume":"33","author":"Weinstein","year":"2008"},{"key":"b35-focus15260","series-title":"J Bone Joint Surg Am","first-page":"1295","article-title":"Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts","volume":"91","author":"Weinstein","year":"2009"},{"key":"b36-focus15260","series-title":"Spine (Phila Pa 1976)","first-page":"1329","article-title":"Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial","volume":"35","author":"Weinstein","year":"2010"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/39\/4\/article-pE15.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/39\/4\/article-pE15.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/39\/4\/article-pE15.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T08:23:36Z","timestamp":1775895816000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/39\/4\/article-pE15.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,10]]},"references-count":72,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2015.7.focus15260","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,10]]}}}