995 - Spinal Cord Stimulation versus Intrathecal Pain Pump for Treating Lumbar Radiculopathy: Outcomes, Complications, and Further Interventions

Spinal cord stimulation (SCS) and intrathecal pain pump (IPP) therapies have emerged as effective options for treatment of chronic pain from refractory lumbar radiculopathy. Both therapies have shown to improve pain outcomes, however, these two modalities have not been compared in the literature. Thus, the current study aimed to compare the effectiveness of SCS versus IPP therapy for treating patients with lumbar radiculopathy.

Design:

TriNetX, a national research network of de-identified patient records, was retrospectively queried for patients with lumbar or lumbosacral radiculopathy. The first group consisted of patients undergoing their first SCS insertion, and the second group of patients underwent their first intrathecal pump implantation. Patients with previous spine surgery or previous implantation of SCS or IPP were excluded. Outcomes were measured within two years of device implantation. Propensity score matching (PSM) was performed for patient demographics, comorbidities, and medications.

Results:

Following PSM, there were 1,358 patients. The SCS group was more likely to receive subsequent lumbar epidural steroid injections (OR: 1.4; 95% CI: 1.035–1.761). The IPP group was more likely to experience device replacement (OR: 1.3; 95% CI: 1.02–1.62), post-procedure CSF leak (OR: 2.9; 95% CI: 1.43–6.06), device-related infection (OR: 2.0; 95% CI: 1.21–3.28), undergo spine surgery (OR: 1.7; 95% CI: 1.09–2.67), be prescribed oral opioids (OR: 1.2; 95% CI: 1.009–1.37) and be diagnosed with anxiety (OR: 1.2; 95% CI: 1.01–1.39) and mood disorders (OR: 1.3; 95% CI: 1.11–1.53) after insertion of the device.

Conclusions:

Within two years of device implantation, patients with refractory chronic lumbar radiculopathy managed with IPPs are more likely to have the IPP catheter replaced, experience device-related complications, undergo spine surgery, and be diagnosed with anxiety or mood disorders. In contrast, patients undergoing SCS are more likely to have lumbar steroid injections. Further investigation comparing the effectiveness of both therapies is warranted.