{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T21:53:00Z","timestamp":1791237180537,"version":"4.1.0"},"reference-count":23,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Spinal cord stimulation has been shown to improve pain relief and reduce narcotic analgesic use in cases of complex refractory pain syndromes. However, a subset of patients ultimately undergoes removal of the spinal cord stimulator (SCS) system, presumably because of surgical complications or poor efficacy. This retrospective study addresses the paucity of evidence regarding risk factors and underlying causes of spinal cord stimulation failures that necessitate this explantation.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>In this retrospective single-center review, 129 patients underwent explantation of SCS hardware during a 9-year period (2005\u20132013) following initial placement at the authors\u2019 institution or elsewhere. Medical history, including indication of implantation, device characteristics, revision history, and reported reasons for removal of hardware, were reviewed.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The 74 (57%) women and 55 (43%) men were a median of 49 years old (IQR 41\u201361 years) at explantation; the median time to explantation was 20 months (IQR 7.5\u201345.5 months). Thoracic or upper lumbar leads were placed in 89.9% of patients primarily for the diagnosis of postsurgical failed\u2013back surgery syndrome (70.5%), chronic regional pain syndrome (14.7%), and neuropathic pain (8.5%). More than half of patients were legally disabled. Initial postoperative reduction in pain was reported in 81% of patients, and 37.8% returned to work. Among 15 patients with acute postsurgical complications (12 infections, 2 hemorrhages, 1 immediate paraplegia), the median time to removal was 2 months. Primary reasons for hardware removal were lack of stimulation efficacy (81%), electrode failure due to migration (14%), and allergic reactions to implanted hardware in 2 patients. The 72 patients who underwent formal psychiatric evaluation before implantation were affected by high rates of major depression (64%), anxiety (34%), posttraumatic stress disorder (PTSD) (12%), drug or alcohol abuse (12%), and physical or sexual abuse (22%).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>The authors\u2019 findings provide insight regarding the mechanisms of spinal cord stimulation failure that resulted in total removal of the implanted system. The relationship between spinal cord stimulation failure and certain psychiatric disorders, such as PTSD, depression, and anxiety, is highlighted. Ultimately, this work may shed light on potential avenues to reduce morbidity and improve patient outcomes.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2019.6.spine181099","type":"journal-article","created":{"date-parts":[[2019,10,4]],"date-time":"2019-10-04T23:08:22Z","timestamp":1570230502000},"page":"133-138","source":"Crossref","is-referenced-by-count":45,"title":["Spinal cord stimulation failure: evaluation of factors underlying hardware explantation"],"prefix":"10.3171","volume":"32","author":[{"given":"Smruti K.","family":"Patel","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Cincinnati College of Medicine;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yair M.","family":"Gozal","sequence":"additional","affiliation":[{"name":"Mayfield Clinic, Cincinnati, Ohio; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed S.","family":"Saleh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Cincinnati College of Medicine;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin L.","family":"Gibson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Cincinnati College of Medicine;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Karsy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George T.","family":"Mandybur","sequence":"additional","affiliation":[{"name":"Mayfield Clinic, Cincinnati, Ohio; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Depress Anxiety","doi-asserted-by":"publisher","first-page":"888","DOI":"10.1002\/da.20600","article-title":"Understanding the co-occurrence of anxiety disorders and chronic pain: state-of-the-art","volume":"26","author":"Asmundson GJ","year":"2009","unstructured":"Asmundson GJ, Katz J: Understanding the co-occurrence of anxiety disorders and chronic pain: state-of-the-art. 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