scholarly journals Is There a Place for Spinal Cord Stimulation in the Management of Patients with Multiple Sclerosis? A Systematic Review of the Literature

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Alessandro Rapisarda ◽  
Eleonora Ioannoni ◽  
Alessandro Izzo ◽  
Manuela D’Ercole ◽  
Nicola Montano
Keyword(s):  
Multiple Sclerosis ◽  
Systematic Review ◽  
Spinal Cord ◽  
Neuropathic Pain ◽  
Spinal Cord Stimulation ◽  
Urinary Dysfunction ◽  
Invasive Technique ◽  
Motor Disorder ◽  
Motor Disorders ◽  
Failed Back Surgery

Objective. Spinal cord stimulation (SCS) is a minimally invasive technique mainly used to treat neuropathic pain associated with failed back surgery syndrome. However, this therapy has been utilized to treat other chronic painful conditions, such as pain associated with multiple sclerosis (MS). Nonetheless, the efficacy of SCS in MS patients has not been fully established. In fact, in most of SCS series, MS patients represent only a subset of a bigger cohort which comprises different causes of pain, motor disorder, and other functional limitations. The aim of our study was to systematically review the literature to evaluate the effectiveness of SCS in MS patients. Methods. A literature search was performed through different databases (PubMed, Scopus, and Embase) using the following terms: “multiple sclerosis,” “spinal cord stimulation,” and “dorsal column stimulation,” according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Results. A total of 452 articles were reviewed, and 7 studies were included in the present analysis. 373 MS patients were submitted to a stimulation trial, and 82 MS patients underwent a de novo implantation. 285/373 (76.4%) of cases submitted to the SCS trial were enrolled for permanent stimulation. We found a long-lasting improvement in 193/346 (55.8%) MS patients with motor disorders, in 90/134 (67.13%) MS patients with urinary dysfunction, and in 28/34 (82.35%) MS patients with neuropathic pain. The efficacy of SCS was higher for urinary dysfunction ( p  = 0.0144) and neuropathic pain ( p  = 0.0030) compared with motor disorders. Conclusions. Our systematic review evidences that SCS is effective in MS patients. Urinary dysfunction and pain symptoms seem to be most responsive to SCS. Further studies are needed to improve the patient selection and clarify the best timing to perform SCS in these patients.

scholarly journals Brain activity modifications following spinal cord stimulation for chronic neuropathic pain: A systematic review

2015 ◽  
Vol 20 (4) ◽  
pp. 499-511 ◽  
Author(s):  
L. D. Bentley ◽  
R. V. Duarte ◽  
P. L. Furlong ◽  
R. L. Ashford ◽  
J. H. Raphael
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Neuropathic Pain ◽  
Spinal Cord Stimulation ◽  
Brain Activity ◽  
Chronic Neuropathic Pain

scholarly journals Treatment Outcomes for Patients with Failed Back Surgery

2017 ◽  
Vol 1 (21;1) ◽  
pp. E29-E43 ◽  
Author(s):  
Jae Hwan Cho
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Back Pain ◽  
Spinal Cord Stimulation ◽  
Spinal Surgery ◽  
Epidural Injection ◽  
Failed Back Surgery Syndrome ◽  
Short Term ◽  
Failed Back Surgery ◽  
Back Surgery

Background: Failed back surgery syndrome (FBSS) is a frequently encountered disease entity following lumbar spinal surgery. Although many plausible reasons have been investigated, the exact pathophysiology remains unknown. Various medications, reoperations, interventions such as spinal cord stimulation, epidural adhesiolysis or epidural injection, exercise therapy, and psychotherapy have been suggested treatment options. However, the evidence of the clinical outcome for each treatment has not been clearly determined. Objectives: To evaluate the outcomes of each treatment modality and to present treatment guidelines for patients with FBSS. Study Design: A systematic review of each treatment regimen in patients with FBSS. Methods: The available literature regarding each modality for the treatment of refractory back pain or radiating pain for FBSS was reviewed. The quality assessment and the level of evidence were analyzed using the “Methodology Checklist” of SIGN (Scottish Intercollegiate Guidelines Network). Data sources included relevant English language literature identified through searches of Pubmed, EMBASE, and Cochrane library from 1980 to Feb 2016. The primary outcome measure was pain relief of back pain or radiating pain for at least 3 months. Secondary outcome measures were improvement of the patient’s functional status, health-related quality of life, return to work, and reduction of opioid use. Results: Twenty-three articles were finally identified and reviewed. Based on our analysis, epidural adhesiolysis showed a short-term (6 to 24 months) effect (grade A) and spinal cord stimulation showed a mid-term (2 or 3 years) effect (grade B). Epidural injections showed a short-term (up to 2 years) effect (grade C). However, other treatments were recommended as grade D or inconclusive. Limitations: The limitations of this systematic review included the rarity of relevant literature. Conclusions: Epidural adhesiolysis or spinal cord stimulation can be effective in order to control chronic back pain or leg pain due to FBSS, and its recommendation grades are A and B, respectively. Other treatments showed poor or inconclusive evidence. Key words: Failed back surgery syndrome, post spinal surgery syndrome, chronic low back pain, post lumbar surgery syndrome, epidural adhesiolysis, spinal cord stimulation, epidural injection, revision

Multicolumn Spinal Cord Stimulation Lead Implantation Using an Optic Transligamentar Minimally Invasive Technique

Neurosurgery ◽  
2013 ◽  
Vol 73 (3) ◽  
pp. 550-553 ◽  
Author(s):  
Philippe Rigoard ◽  
Anh Tran Luong ◽  
Alexandre Delmotte ◽  
Mille Raaholt ◽  
Manuel Roulaud ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Failed Back Surgery Syndrome ◽  
Leg Pain ◽  
Invasive Technique ◽  
Lower Back ◽  
Lead Placement ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
New Generation

Abstract BACKGROUND: A new generation of neurostimulation surgical leads is used to increase the success of spinal cord stimulation in difficult-to-treat indications such as failed back surgery syndrome. Minimal access spinal technologies (MASTs) have previously been used for surgical lead implantation. However, only a unilateral approach was possible, causing difficulties for median lead placement, and not always preventing laminectomy. A recent MAST technique was used to implant spinal cord stimulation leads without these limitations. OBJECTIVE: To describe the MAST technique used in a pilot study. METHODS: Twenty-four consecutive patients were implanted with a multicolumn surgical lead for refractory chronic back and leg pain by using the optic transligamentar MAST technique. RESULTS: The MAST technique allowed median lead placement, facilitated visualization of the spine, and permitted transligamentar insertion that minimized scarring and muscle damage. No technique-related adverse events or lead revisions were reported. CONCLUSION: Use of a MAST approach could be useful in safe implantation of multicolumn surgical leads in difficult-to-treat, refractory lower back pain conditions such as failed back surgery syndrome.

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