Incidence and etiology of impediments to spinal cord stimulator trial progression

Background Spinal cord stimulator (SCS) trials are used to assess therapy efficacy before permanent implantation. Despite initial candidacy, not all patients proceed to SCS trial. Comprehending potential barriers to SCS therapy could offer strategies to enhance patient access. Objective The purpose of this study is to evaluate the incidence and etiology of impediments to SCS trial progression unrelated to preoperative MRI findings. Methods A retrospective chart review of a single center identified patients who were under consideration for SCS trial from September 2013 to July 2023. Impediments to trial progression were classified from electronic health records. Demographic variables and time intervals were analyzed using logistic regression and a non-parametric test. Results This retrospective study identified 358 patients considered for an SCS trial of which 84 (23.5%) did not progress. Relevant impediment classifications included: medical reasons (39.8%), patient-directed decisions (25.8%), insurance or financial responsibilities (16.1%), MRI-documented contraindications (10.8%), and psychiatric concerns (7.5%). In the multivariable logistic regression, complex regional pain syndrome (CRPS; b = −0.82, p = 0.04) was the only demographic variable significantly associated with non-progression to trial. Conclusion Across all SCS trial candidates, 20.7% did not progress for reasons unrelated to MRI findings. SCS trial progression was hindered by medical, personal, and financial challenges during the preoperative period. These findings highlight a need for enhancing patient access and optimizing preprocedural processes.