As submitted to: Neuromodulation And later published: Awake versus Asleep Placement of Spinal Cord Stimulators: A Cohort Analysis of Complications Associated with Placement

Introduction: Patients will typically undergo awake surgery for permanent implantation of SCS in an attempt to optimize electrode placement using patient feedback about the distribution of stimulation-induced paresthesia. The present study compared efficacy of first-time electrode placement under awake conditions with that of neurophysiologicallyguided placement under general anesthesia. Methods: A retrospective review was performed of 387 SCS surgeries among 259 patients which included 167 new stimulator implantation to determine whether first time awake surgery for placement of spinal cord stimulators is preferable to non-awake placement. Results: The incidence of device failure for patients implanted using neurophysiologically-guided placement under general anesthesia was one-half that for patients implanted awake (14.94% vs 29.7%). Conclusion: Non-awake surgery is associated with fewer failure rates and therefore fewer re-operations, making it a viable alternative. Any benefits of awake implantation should carefully be considered in the future.