A Feasibility Study Exploring Measures of Autonomic Function in Patients With Failed Back Surgery Syndrome Undergoing Spinal Cord Stimulation

Abstract INTRODUCTION Spinal cord stimulation (SCS) is an effective treatment option for low back pain and radicular leg pain of failed back surgery syndrome (FBSS). In a recent study, high-frequency spinal cord stimulation (HFSCS) was found to be more effective in treating chronic pain than traditional paresthesia-based low-frequency SCS (paresthesia SCS). The purpose of this study is to evaluate the efficacy of paresthesia SCS and HFSCS in improving outcomes. METHODS We retrospectively reviewed the outcomes of patients who underwent paresthesia SCS or HFSCS between September 2016 and January 2019. Paresthesia SCS is generally characterized by programming stimulation parameters such that the patient experiences paresthesia, and the paresthesia topography overlaps the pain topography as much as possible. The patient in HFSCS had a placement of cylindrical lead at levels T9-10. Patients were programmed with the electrode overlying the inferior endplate of T9 (+) and the electrode overlying the superior endplate of T10 (–). RESULTS A total of 14 patients (4 males, 10 females) underwent paresthesia SCS implantation. Mean age was 77.2 ± 9.6 yr. A total of 5 patients (2 males, 3 females) underwent HFSCS implantation. Mean age was 78.2 ± 7.5 yr. Operative time was shorter for the HFSCS group compared to the paresthesia SCS group (53.4 ± 4.8 min vs 82.9 ± 20.3 min, respectively; P < .001). A total of 5 out of 5 patients in the HFSCS group (100%) and 10 out of 14 patients in the paresthesia SCS group (71.4%) achieved the outcome of 50% pain relief (P = .25) CONCLUSION To confirm paresthesia during the procedure in the elderly may be complicated by hearing/language difficulties or by sedative-related confusion. Compared to paresthesia SCS, HFSCS allows for lower operative times and a more efficient and accurate positioning of the electrodes.

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Importância da neuroestimulação medular no tratamento da síndrome do insucesso da cirurgia espinal

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0038-1626259 ◽

2014 ◽

Vol 33 (02) ◽

pp. 119-124

Author(s):

Isabela Palmeira Gomes ◽

Otaviano Ottoni da Silva Netto ◽

Rodrigo Almeida Matos ◽

Ledismar José da Silva

Keyword(s):

Spinal Cord ◽

Spinal Cord Stimulation ◽

Failed Back Surgery Syndrome ◽

Failed Back Surgery ◽

Back Surgery

ResumoEletrodos vêm sendo utilizados desde 1967 para estimulação da coluna espinal (em inglês, spinal cord stimulation – SCS) no tratamento de dor crônica refratária em uma série de distúrbios dolorosos, entre eles a síndrome do insucesso da cirurgia espinal (em inglês, failed-back surgery syndrome – FBSS), caracterizada por dor persistente após cirurgias de coluna, principalmente laminectomia. Neste artigo, apresenta-se uma revisão sistemática da literatura sobre o estudo da neuromodulação no tratamento da FBSS, utilizando-se as plataformas dos portais virtuais PubMed e MedLine, com o objetivo de levantar evidências que corroborem a eficácia e a segurança desse procedimento para dor crônica lombar decorrente de FBSS. A seleção dos estudos, publicados no período entre janeiro de 2003 e janeiro de 2013, envolveu critérios de análise de eficácia (melhora da dor, com redução de 50% ou mais, utilizando a Escala Visual Analógica – VAS – ou outras similares) e de segurança (quando complicações foram citadas). Foram inicialmente identificados 186 artigos, entre os quais nove foram selecionados por preencherem os critérios de inclusão/exclusão, totalizando 313 pacientes. Em todos os trabalhos selecionados, observou-se melhora considerável da dor após os procedimentos neuromodulatórios. Conclui-se que, quando bem indicada, a SCS é mais eficaz do que a reoperação ou qualquer outro tipo de terapia conservadora no tratamento de dor crônica lombossacral.

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