Back Pain: A Real Target for Spinal Cord Stimulation?

Neurosurgery ◽  
2011 ◽  
Vol 70 (3) ◽  
pp. 574-585 ◽  
Author(s):  
Philippe Rigoard ◽  
Alexandre Delmotte ◽  
Samuel D'Houtaud ◽  
Lorraine Misbert ◽  
Bakari Diallo ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Back Pain ◽  
Pain Relief ◽  
Visual Analog Scale ◽  
Spinal Cord Stimulation ◽  
Failed Back Surgery Syndrome ◽  
Analog Scale ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Pain Visual Analog Scale

Abstract Background: Failed back surgery syndrome represents one of the most frequent etiologies of chronic back pain and is a major public health issue. Neurostimulation has currently not been validated in the treatment of back pain because of technological limitations in implantable spinal cord stimulation (SCS) systems. New-generation leads using several columns of stimulation can generate longitudinal and/or transverse stimulation fields into the spinal cord. Objective: To investigate, through extensive stimulation testing, the capacity of multicolumn tripolar leads to achieve back territory paresthesia coverage in refractory failed back surgery syndrome patients. Methods: Eleven patients implanted with a 16-contact spinal cord stimulation lead (Specify 5-6-5, Medtronic Inc) were assessed with a systematic exploration of 43 selected stimulation configurations to generate bilateral back paresthesia in addition to leg territory coverage. Results: The tripolar lead successfully generated paresthesia in both bilateral back and leg territories in 9 patients (81.8%). Success rates of multicolumn stimulation patterns were significantly higher than for longitudinal configurations for lombodorsal paresthesia coverage. Six months after implantation, significant pain relief was obtained compared with preoperative evaluation for global pain (Visual Analog Scale, 2.25 vs 8.2 preoperatively; P < .05), leg pain (Visual Analog Scale, 0.5 vs 7.6 preoperatively; P < .05), and back pain (Visual Analog Scale, 1.5 vs 7.8 preoperatively; P < .05). Conclusion: These results suggest that multicolumn leads can reliably generate back pain coverage and favor pain relief outcomes. This may lead physicians to reconsider new indications for spinal cord stimulation. Expanding neurostimulation perspectives to intractable back pain syndromes could become realistic in the near future.

Efficacy of Transverse Tripolar Spinal Cord Stimulator for the Relief of Chronic Low Back Pain from Failed Back Surgery

2008 ◽  
Vol 3;11 (5;3) ◽  
pp. 333-338
Author(s):  
Asokumar Buvanendran
Keyword(s):  
Spinal Cord ◽  
Low Back Pain ◽  
Back Pain ◽  
Case Report ◽  
Pain Relief ◽  
Failed Back Surgery Syndrome ◽  
Low Back ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Stimulation Of

Background: Failed back surgery syndrome is a common clinical entity for which spinal cord stimulation has been found to be an effective mode of analgesia, but with variable success rates. Objective: To determine if focal stimulation of the dorsal columns with a transverse tripolar lead might achieve deeper penetration of the electrical stimulus into the spinal cord and therefore provide greater analgesia to the back. Design: Case report. Methods: We describe a 42-year-old female with failed back surgery syndrome that had greater back pain than leg pain. The tripolar lead configuration was achieved by placing percutaneously an octapolar lead in the spinal midline followed by 2 adjacent quadripolar leads, advanced to the T7-T10 vertebral bodies. Results: Tripolar stimulation pattern resulted in more than 70% pain relief in this patient during the screening trial, while stimulation of one or 2 electrodes only provided 20% pain relief. After implantation of a permanent tripolar electrode system with a single rechargeable battery, the pain relief was maintained for one year. Conclusion: This is case report describing a case of a patient with chronic low back pain with a diagnosis of failed back surgery syndrome in which transverse tripolar stimulation using an octapolar and 2 quadripolar leads appeared to be beneficial. The transverse tripolar system consists of a central cathode surrounded by anodes, using 3 leads. This arrangement may contribute to maximum dorsal column stimulation with minimal dorsal root stimulation and provide analgesia to the lower back. Key words: Epidural, low back pain, spinal cord stimulation, failed back surgery syndrome, tripolar stimulation

scholarly journals Complex Regional Pain Syndrome and Failed Back Surgery Syndrome With Failed High-Frequency Spinal Cord Stimulation Salvaged With Arthrodesis Revision Surgery and Burst Therapy

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Erin McCormack ◽  
Mansour H Mathkour ◽  
Lora Wallis Kahn ◽  
Maged Guirguis ◽  
Gassan Chaiban ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Back Pain ◽  
Pain Relief ◽  
High Frequency ◽  
Pain Syndrome ◽  
Failed Back Surgery Syndrome ◽  
Foot Pain ◽  
Failed Back Surgery ◽  
Back Surgery

Abstract INTRODUCTION Complex regional pain syndrome (CRPS) is a disabling form of constant and intense chronic pain involving a limb. Failed back surgery syndrome (FBSS) is chronic back pain following back surgery. Burst stimulation is a novel concept applied recently to treat chronic pain through spinal cord stimulation (SCS). The impulses are thought to travel to the thalamus to treat sensory, affective, and attentional components of neuropathic pain by targeting both the somatosensory cortex and the limbic system. METHODS A 50-yr-old female presented 1 yr after L5-S1 posterior instrumentation and posterolateral arthrodesis for spondylolisthesis with disabling Type I CRPS of her left foot and back pain. Postoperative improvement in back pain was noted but her left leg pain became worse despite SCS reprogramming. Two months later, she underwent placement of a different paddle lead at T12 and a new pulse generator using burst therapy. This resulted in complete resolution of foot pain. She remains pain-free 5 mo postoperatively. RESULTS Our patient underwent a T9-T10 high frequency (10 kHz) SCS trial followed by permanent paddle lead placement at T9-10 which provided more than 50% foot pain relief resulting in improved range of motion. However, worsening back pain and pseudoarthrosis mandated a revision of her prior arthrodesis 6 mo after SCS surgery. CONCLUSION In selected patients with FBSS and CRPS, revision of arthrodesis combined with SCS may be needed to achieve adequate pain relief. Burst therapy may be superior to high frequency stimulation in select patients.

scholarly journals Multicolumn spinal cord stimulation for predominant back pain in failed back surgery syndrome patients

Pain ◽  
2019 ◽  
Vol 160 (6) ◽  
pp. 1410-1420 ◽  
Author(s):  
Philippe Rigoard ◽  
Surajit Basu ◽  
Mehul Desai ◽  
Rod Taylor ◽  
Lieven Annemans ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Back Pain ◽  
Spinal Cord Stimulation ◽  
Failed Back Surgery Syndrome ◽  
Failed Back Surgery ◽  
Back Surgery

Long-Term Outcome of Spinal Cord Stimulation in Failed Back Surgery Syndrome: 20 Years of Experience With 224 Consecutive Patients

Neurosurgery ◽  
2018 ◽  
Vol 84 (5) ◽  
pp. 1011-1018 ◽  
Author(s):  
Mette Nissen ◽  
Tiina-Mari Ikäheimo ◽  
Jukka Huttunen ◽  
Ville Leinonen ◽  
Mikael von und zu Fraunberg
Keyword(s):  
Spinal Cord ◽  
Pain Relief ◽  
Spinal Cord Stimulation ◽  
Failed Back Surgery Syndrome ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Failed Back Surgery ◽  
Back Surgery

Abstract BACKGROUND Failed back surgery syndrome (FBSS) is a challenging condition that lacks a curative treatment. In selected patients, spinal cord stimulation (SCS) has provided a satisfactory outcome. OBJECTIVE To evaluate the long-term outcome of SCS in FBSS, as measured by (1) the explantation rate, (2) complications, and (3) patient satisfaction with the global perceived effect (GPE). METHODS We studied 224 consecutive FBSS patients who underwent an SCS trial with surgically implanted leads at our hospital between January 1996 and December 2014. The patients’ satisfaction with the GPE of treatment was measured through a postal questionnaire at the end of follow-up. RESULTS Based on a 1-wk trial, permanent SCS was implanted in 175 (78%) patients. Out of these patients, 153 (87%) reported satisfactory outcomes after 2 mo. During the mean follow-up of 6 yr, 34 (19%) of SCS devices were permanently explanted due to inadequate pain relief, and 11 (6%) were explanted for other reasons. Electrode revision due to inadequate pain relief was done for 22 patients. In total, 26 complications were reported due to: 7 deep infections, 11 hardware malfunctions, 1 subcutaneous hematoma, 4 instances of discomfort due to the pulse generator, and 3 electrode migrations. One hundred thirty patients (74%) continued with SCS until the end of follow-up. Of them, 61 (47%) returned the questionnaire, and 42 (69%) reported substantially improved or better GPE. CONCLUSION SCS can provide a good outcome in the treatment of FBSS. Patient selection could be further improved by developing novel predictive biomarkers.

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