gms | German Medical Science

Objective: Patients displaying failed back surgery syndrome (FBSS) often represent a therapy and social challenge with elevated costs deriving from drug- and physical therapy as well as from work incapacity. Implant od spinal cord stimulation (SCS) epidural electrodes is a proven successful method to treat lower limb pain but the efficacy to control low back pain remains unsatisfactory for most of patients. We have evaluated feasibility and patient comfort regarding low back pain control after therapy with hybrid systems including both SCS and subcutaneous peripheral nerve field stimulation (PNFS) electrodes compared to SCS in stand-alone technique.

Method: 23 consecutive patients (9 females, 14 males, mean age: 49.5 y.) suffering of FBSS after multiple spine surgical procedures and with confirmed refractory pain after extensive multimodal pain therapy regimes were enrolled in this observational study. Fourteen patients received SCS alone consisting in 8-contact leads (6 females, 8 males, mean age: 46y. and 56y. respectively), whereas 6 patients had undergone implantation of SCS in combination with PNFS subcutaneous stimulation consisting in 4-contact leads, in the middle of pain area (3 females, 3 males, mean age: 68y. and 49y. respectively). Pulse generators were only implanted when patients reported more than 50% pain relief during the trial time. Pain control was assessed by VAS after 12 months treatment and compared with pain at baseline. t-test was performed for statistical analysis.

Results: After 12 months, SCS alone was successful for pain relief of lower limb (VAS0:73 vs. VAS12:26, p<0,05). PNFS together with SCS significantly reduced both lower limb- and low back pain (VAS0:82 vs. VAS12:45, p<0,05). In the last group, two patients returned to work. There were three treatment failures with removal of the system in the group of SCS alone.

Conclusions: The combination of SCS and PNFS appears to be an effective treatment regime for patients suffering from refractory FBSS, particularly regarding low-back pain for which SCS alone is insufficient in ameliorating pain syndrome.