Real-World Outcomes of Spinal Cord Stimulation: A Consecutive Institutional Experience with 505 Trials, Trial-to-Implant Ratio, Long-Term Efficacy, and Explantation Risk Factors.

Objective: This study aimed to evaluate the real-world outcomes of spinal cord stimulation (SCS) therapy in chronic pain management. Specifically, it investigated trial success rates, trial-to-permanent implant conversion, sustained post-implant efficacy, opioid use reduction, and risk factors for device explantation. Materials and Methods: In this single-center retrospective observational cohort study, 505 adult patients who underwent SCS trials between January 2022 and January 2024 at a specialized pain management center were included. Demographic, clinical, and procedural data were extracted from electronic medical records. Trial success was defined as ≥50% pain relief at the time of lead pull. Permanent implant success was defined as ≥50% improvement in pain and function at final follow-up without explantation. Logistic regression was used to identify predictors of explantation. Results: The mean age was 67.5 ± 12.4 years, and 64.2% of patients were female. Overall, 86.1% of patients achieved trial success, and 77.0% proceeded to permanent implantation. At follow-up (range: 3-34 months), 76.6% of implanted patients maintained significant improvement. Patients diagnosed with diabetic neuropathy showed the highest success rate (83.3%), while patients living with CRPS had the lowest (67.6%). Opioid use decreased in 58.9% of patients. The overall explant rate was 14.1%, with loss of efficacy as the leading cause. Lead migration and infection were the most frequent complications. Tobacco use, depression, chronic opioid use, and post-implant falls were statistically significant predictors of explantation (p <0.05). Conclusion: SCS continues to be a clinically effective treatment for chronic refractory pain, with high trial success and durable benefit for most patients. However, certain patient-specific factors are associated with an increased likelihood of device failure and explantation. Identifying these risk factors may improve patient selection and long-term outcomes. Further prospective studies are warranted.