Sex Differences in Rates of Spinal Cord Stimulation Therapy and Spinal Cord Stimulator Explants: A Propensity-Score Matched Analysis

Maria Grabnar; Richard Wilson

doi:10.1016/j.neurom.2024.12.002

Sex Differences in Rates of Spinal Cord Stimulation Therapy and Spinal Cord Stimulator Explants: A Propensity-Score Matched Analysis

Neuromodulation. 2025 Jan 7:S1094-7159(24)01268-6. doi: 10.1016/j.neurom.2024.12.002. Online ahead of print.

Authors

Maria Grabnar¹, Richard Wilson²

Affiliations

¹ MetroHealth Rehabilitation Institute, Metrohealth System, Cleveland, OH, USA; Department of Physical Medicine and Rehabilitation, Case Western Reserve University School of Medicine, Cleveland, OH, USA. Electronic address: mgrabnar@metrohealth.org.
² MetroHealth Rehabilitation Institute, Metrohealth System, Cleveland, OH, USA; Department of Physical Medicine and Rehabilitation, Case Western Reserve University School of Medicine, Cleveland, OH, USA.

PMID: 39772340
DOI: 10.1016/j.neurom.2024.12.002

Abstract

Objectives: Spinal cord stimulation (SCS) is a therapeutic option for those with chronic pain due to persistent spinal pain syndrome (PSPS). Current literature suggests a higher rate of SCS explant in female patients, but evidence regarding sex differences in the rates of receiving SCS therapy is limited. We do not know whether there is a disparity between female and male patients who receive SCS therapy. The objectives of this retrospective analysis were to determine whether there is a sex-based disparity in SCS therapy and SCS explants between female and male patients for the treatment of PSPS.

Materials and methods: This retrospective study included medical record data from TriNetX US collaborative research network (TriNetX, Inc, Cambridge, MA), which included 61 large US healthcare organizations. Patients with a diagnosis of PSPS were identified. From the PSPS cohort, those who received SCS therapy (leads and/or generator) were included for the primary outcome, which was to compare the rates of SCS therapy in women and men, and those who received SCS explants were included for the secondary outcome. Propensity matched scoring was used to ensure comparability of cohorts.

Results: The propensity-score matched sample included 87,681 female and 87,681 male patients for analysis, with SCS therapy being provided to 6782 women (risk of 7.735%) and 6783 men (risk of 7.736%), with a risk difference of -0.001%, 95% CI (-0.251%, 0.249%), z = -0.009, p = 0.9929. Within the same propensity-score matched sample, SCS explant occurred in 2999 women (risk of 3.420%) and 2608 men (risk of 2.974%). The risk difference was 0.446%, 95% CI (0.281%, 0.611%), z = 5.307, p < 0.0001.

Conclusions: Our retrospective analysis shows that there is not a difference in the rates of SCS therapy between a matched sample of women and men with PSPS, and a small difference in rates of SCS explants between women and men.

Keywords: Neuromodulation; pain; persistent spinal pain syndrome; sex; spinal cord stimulator.