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Abstract Objective We hypothesize that reoperation rates of spinal cord stimulation (SCS) systems utilizing percutaneous leads are comparable to those utilizing paddle leads. We attempt here to characterize causes for those reoperations and identify any related patient characteristics. Design and Subjects This study is a single-center retrospective chart review of 291 subjects (410 operations) who underwent at least one permanent SCS implantation utilizing percutaneous or paddle leads over a 10-year period at the Medical University of South Carolina. Methods Charts were reviewed for height, weight, body mass index, gender, race, age, stimulator type, type of reoperation, diabetes status, history and type of prior back surgery, top lead location, and number of leads placed. Comparisons of patient and procedural characteristics were conducted using a two-sample t test (continuous variables), chi-square, or Fisher exact approach (categorical variables). Univariate and multivariate Cox regression models were developed, identifying associations between patient characteristics, SCS characteristics, reoperation rates, and time to reoperation. Results Thirty point five eight percent of subjects (89/291), required at least one reoperation. The reoperation rate was 27.84% for percutaneous systems (N = 54/194) and 27.78% for paddle systems (N = 60/216). Time to reoperation also did not differ between the two systems (hazard ratio [HR] = 1.06, 95% CI = 0.70–1.60). Of all factors examined, younger age at time of placement was the only factor associated with risk of reoperation (HR = 0.73, 95% CI = 0.62–0.87, P < 0.001). Conclusions Our data suggest that reoperation rates and time to reoperation between percutaneous and paddle leads are clinically similar; therefore, rates of reoperation should have no bearing on which system to choose.

The safety of neuraxial anesthetic techniques in the setting of oral and parenteral anticoagulation is an area of growing interest and clinical inquiry as the multitude of anticoagulant medications rapidly increases. Additionally, the indications for spinal cord stimulation therapy are evolving as both technique and technology in the field continue to advance. The estimated incidence of spinal hematoma following epidural injection has been estimated to be 1 in 150,000-200,000. However, there is very little data on the risk of indwelling spinal cord simulation leads and chronic use of anticoagulant medications. We would like to report a recent case for consideration in which a spinal cord stimulator trial was successful and led to permanent spinal cord stimulator implantation in a patient with diabetic peripheral neuropathy taking life-long aspirin and clopidogrel therapy secondary to extensive coronary and carotid atherosclerosis. The report serves as a novel case to encourage exploration into the topic of anticoagulation therapy with indwelling spinal cord stimulator leads. The case brings up a number of critical questions that cannot clearly be answered with the current literature and some interesting topics for discussion including the need for acute systemic anticoagulation in the future for vascular interventions and risk stratification for those patients selected for spinal cord stimulation.

President Biden today had his first big meeting with allies ashe prepares for the showdown with Putin. Interview with White HousePress Secretary Jen Psaki. Rep. Pramila Jayapal (D-WA) is interviewedabout the infrastructure deal. GUESTS: Jen Psaki, Pramila Jayapal

President Biden issues an urgent plea to the unvaccinated toget their shots as he faces a new COVID emergency and Biden begs getvaccinated ahead of expected vaccine mandate for federal workers.Activists are growing impatient with President Biden as votinglegislation seems to stall in Congress. The Senate now voting on thismotion to suspend cloture, which is the procedural move to get to thenext stage of infrastructure deal process. GUESTS: Paul Offit, Adam Schiff, Adam Kinzinger, Martin Luther KingIII

The U.S. is ringing in the new year amid a COVID-19 surge thatexperts warn is exploding at unprecedented speed and could alter dailylife for many Americans during the first month of 2022. With morevirus spreading in the country, more than 30 colleges and universitiesare changing the start of their spring semester and more children aregetting sick and being hospitalized than at any other point in thepandemic just as their school will be navigating reopening after theholidays. As the highly transmissible Omicron variant roars across thecountry, the Biden administration is revealing the most tangible signsof a shifting pandemic strategy several weeks in the making. GUESTS: Jayne Morgan, Steven Anderson, Grace Gaustad