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Review
. 2024 Nov 26:4:104148.
doi: 10.1016/j.bas.2024.104148. eCollection 2024.

Meta-analysis and review of rechargeable implantable pulse generators for spinal cord stimulation and deep brain stimulation

Denizhan Özgan  1 , Sandro M Krieg  2   3 , Martin Jakobs  2   4   3
Affiliations
Review

Meta-analysis and review of rechargeable implantable pulse generators for spinal cord stimulation and deep brain stimulation

Denizhan Özgan et al. Brain Spine. .

Abstract

Introduction: Neuromodulation through deep brain stimulation (DBS) and spinal cord stimulation (SCS) has become a successful therapy for various neurological disorders, such as movement disorders and chronic pain. Implantable pulse generators (IPGs) are pivotal in these therapies, available as either rechargeable (r-IPGs) or non-rechargeable (nr-IPGs).

Research question: To perform a meta-analysis on r-IPGs.

Methods: A systematic literature search following PRISMA guidelines was conducted on PubMed, focusing on studies published from January 2005 to August 2023. Included studies comprised clinical trials, randomized controlled trials, and comparative studies involving human subjects. Data extraction focused on patient demographics, stimulation types, battery characteristics, and complications. Descriptive statistics and Pearson correlation analyses were performed using SPSS software.

Results: Nine studies involving 288 patients with rechargeable IPGs (r-IPGs) for SCS and 257 patients with r-IPGs for DBS met the inclusion criteria. r-IPGs exhibited low rates of surgical revisions and infections, with surgical revision rates of 8.87% for SCS and 5.45% for DBS, and infection rates of 2.6% for SCS and 1.56% for DBS. Charge burden was comparable with 97.34 min and 93.41 min per week for SCS and DBS respectively. Correlation analyses indicated that longer battery recharge times were associated with an increased incidence of complications, including unintentional interruptions and hardware failures.

Discussion: r-IPGs may offer substantial benefits in reducing re-operation rates and complications associated. Nonetheless, careful management of battery charging is crucial to maximize these benefits. Establishing international guidelines for the use of r-IPGs in specific patient populations and conditions is recommended to standardize and optimize outcomes.

Keywords: Deep brain stimulation; Implantable pulse generator; Rechargeable; Spinal cord stimulation.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Martin Jakobs has received educational grants from Boston Scientific and inomed Medizintechnik as well as speaking grants from Precisis GmbH. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Adapted PRISMA 2020 flow diagram.
Fig. 2
Fig. 2
Surgery-related complications of rechargeable IPGs. Rates of infection and surgical revisions for both DBS (a & b) and SCS (c & d) therapy.
Fig. 3
Fig. 3
Hardware related complication for rechargeable IPGs. Rates of failure of implanted and explanted parts for both DBS (a & b) and SCS (c & d) therapy.
See this image and copyright information in PMC

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