Real-Time Pressure Sensing Is Associated With Reduced Complication Rates in Percutaneous Spinal Cord Lead Implantation: A Retrospective Cohort Analysis

BACKGROUND AND OBJECTIVES: – CompuFlo provides real-time pressure feedback to identify the epidural space during spinal cord stimulator (SCS) implantation.METHODS: – We compared CompuFlo with standard loss of resistance. Single-center retrospective cohort of consecutive SCS implantations by one surgeon using CompuFlo or loss of resistance. Primary outcome: composite of any cerebrospinal fluid leak, epidural blood patch, or postoperative radiculopathy. Secondary outcomes: each component, needle-pass burden (mean passes per electrode; ≥2 passes), operative time, and hospital length of stay (LOS). Models adjusted for age, sex, and entry level.RESULTS: – Seventy-nine patients were included (CompuFlo n = 40; standard n = 39). CompuFlo patients were older, with similar sex and race distributions. Entry level differed numerically between groups. Multiple attempts, mean needle passes per electrode, and LOS were similar. In adjusted analyses, CompuFlo guidance was associated with lower odds of any complication (adjusted odds ratio 0.09, 95% CI 0.00-0.90; P = .039). Individual complications, ≥2 passes, pass rate, operative time, and LOS did not differ. Among CompuFlo cases with pressure recordings (n = 19), first-pass high pre-epidural pressures averaged 137.6 ± 8.4 mm Hg and low epidural pressures averaged 20.0 ± 13.6 mm Hg.CONCLUSION: – CompuFlo-guided epidural access during SCS implantation was associated with lower adjusted odds of perioperative complications without increased needle-pass burden or LOS. Larger prospective studies are warranted.