TY - JOUR

T1 - Spinal Cord Stimulation–Naïve Patients vs Patients With Failed Previous Experiences With Standard Spinal Cord Stimulation

T2 - Two Distinct Entities or One Population?

AU - Goudman, Lisa

AU - Rigoard, Philippe

AU - Billot, Maxime

AU - De Smedt, Ann

AU - Roulaud, Manuel

AU - Consortium, Discover

AU - Moens, Maarten

AU - Eykens, Tom

AU - De Keersmaecker, Kelly

AU - Gorissen, Mayken

AU - De Clerck, Christ

AU - Donck, Ann Ver

AU - Braems, Hannie

AU - Buyse, Klaas

AU - Puylaert, Martine

AU - Duyvendak, Wim

AU - De Smet, Chris

AU - Vissers, Steven

AU - Debeuf, Johan

AU - De Beucker, Kim

AU - Ceuppens, Jeroen

AU - Germonpré, Pieter Jan

AU - Mortier, Sarah

AU - Van Buyten, Jean Pierre

AU - Smet, Iris

AU - Devos, Marieke

AU - Vanhauwaert, Dimitri

AU - Billet, Bart

AU - Hanssens, Karel

AU - Demeyere, Annemarie

AU - Casier, Tine

AU - Bertrem, Bénédicte

AU - Van Havenbergh, Tony

AU - Van Looy, Pieter

AU - Heylen, Gertje

AU - de Schryver, Catherine

AU - Vangeneugden, Johan

AU - Louis, Frédéric

AU - Stalmans, Virginie

AU - Remacle, Jean Michel

AU - Remacle, Thibault

AU - Mauviel, Stéphane

AU - Abeloos, Laurence

AU - Theys, Tom

AU - Van Hoylandt, Anaïs

AU - Bruyninckx, Dominike

AU - Das, John

AU - Callebaut, Ina

AU - Lorgeoux, Bertille

AU - Van Hooff, Robbert Jan

AU - Discover Consortium

N1 - Publisher Copyright: © 2022 International Neuromodulation Society

PY - 2023

Y1 - 2023

N2 - Introduction: Nowadays, the success of spinal cord stimulation (SCS) is evaluated separately in patients who have previous experiences with standard SCS and in SCS-naïve patients. Nevertheless, it is yet to be evaluated whether both patient groups are effectively distinct patient groups. Therefore, the aims of this study are twofold: 1) Are there clusters in the data to distinguish between both patient groups? 2) Can we discriminate both patient groups based on routinely collected clinical parameters? Materials and Methods: Baseline data from the Discover study were used, in which 263 patients with persistent spinal pain syndrome type 2 were included (185 neurostimulation-naïve patients and 78 patients with previous SCS experience). Pain intensity scores for low back and leg pain, functional disability, medication use, and health-related quality of life utility scores were used in the analysis. Model-based clustering was performed on standardized data. Discriminant analysis was performed with linear and quadratic discriminant analysis, with leave-one-out cross-validation to evaluate model performance. Results: Model-based clustering revealed two different clusters in the data. None of the clusters clearly separated SCS-naïve patients from patients with previous SCS experience. Linear discriminant analysis resulted in a leave-one-out cross-validation error rate of 30.0% to discriminate between both patient groups, based on routinely collected clinical parameters. Conclusions: Clustering analysis did not result in clusters that separate SCS-naïve patients from patients with previous SCS experience. This may suggest that both patient groups should not be considered as two different patient groups when comparing them on routine clinical parameters, with potentially profound implications for research and clinical settings. Clinical Trial Registration: The Clinicaltrials.gov registration number for the Discover study is NCT02787265.

AB - Introduction: Nowadays, the success of spinal cord stimulation (SCS) is evaluated separately in patients who have previous experiences with standard SCS and in SCS-naïve patients. Nevertheless, it is yet to be evaluated whether both patient groups are effectively distinct patient groups. Therefore, the aims of this study are twofold: 1) Are there clusters in the data to distinguish between both patient groups? 2) Can we discriminate both patient groups based on routinely collected clinical parameters? Materials and Methods: Baseline data from the Discover study were used, in which 263 patients with persistent spinal pain syndrome type 2 were included (185 neurostimulation-naïve patients and 78 patients with previous SCS experience). Pain intensity scores for low back and leg pain, functional disability, medication use, and health-related quality of life utility scores were used in the analysis. Model-based clustering was performed on standardized data. Discriminant analysis was performed with linear and quadratic discriminant analysis, with leave-one-out cross-validation to evaluate model performance. Results: Model-based clustering revealed two different clusters in the data. None of the clusters clearly separated SCS-naïve patients from patients with previous SCS experience. Linear discriminant analysis resulted in a leave-one-out cross-validation error rate of 30.0% to discriminate between both patient groups, based on routinely collected clinical parameters. Conclusions: Clustering analysis did not result in clusters that separate SCS-naïve patients from patients with previous SCS experience. This may suggest that both patient groups should not be considered as two different patient groups when comparing them on routine clinical parameters, with potentially profound implications for research and clinical settings. Clinical Trial Registration: The Clinicaltrials.gov registration number for the Discover study is NCT02787265.

KW - Clustering

KW - discriminant analysis

KW - failed back surgery syndrome

KW - machine learning

KW - persistent spinal pain syndrome type 2

U2 - 10.1016/j.neurom.2022.04.037

DO - 10.1016/j.neurom.2022.04.037

M3 - Journal article

C2 - 35551868

AN - SCOPUS:85132668897

VL - 26

SP - 157

EP - 163

JO - Neuromodulation: Technology at the Neural Interface

JF - Neuromodulation: Technology at the Neural Interface

SN - 1094-7159

IS - 1

ER -