gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Lumbar nerve field stimulation for the treatment of chronic lumbar pain – a standardized approach to improve therapeutic success

Meeting Abstract

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  • C. Wille - Neurochirurgische Klinik, Abteilung für Neuromodulation, Universitätsklinikum Düsseldorf
  • J. Perrin - Neurochirurgische Klinik, Abteilung für Neuromodulation, Universitätsklinikum Düsseldorf
  • S. Schu - Neurochirurgische Klinik, Abteilung für Neuromodulation, Universitätsklinikum Düsseldorf
  • J. Vesper - Neurochirurgische Klinik, Abteilung für Neuromodulation, Universitätsklinikum Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocFR.11.01

DOI: 10.3205/12dgnc255, URN: urn:nbn:de:0183-12dgnc2552

Published: June 4, 2012

© 2012 Wille et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: Chronic lumbar pain remains a difficult to address symptom in spite of advances made in electrode design and implantation techniques for SCS. Trials with subcutaneous electrodes implanted within or around the painful section often end in frustration. Recently we introduced electro-acupuncture mapping as a test tool for PNS. A case series and a treatment algorithm for lumbar nerve field stimulation based on mapping results are presented.

Methods: 16 patients with chronic lumbar pain underwent electro-acupuncture mapping twice and subsequent electrode implantation. A positive test result resembles paresthesia and numbness within the pain area provoking lasting pain reduction for more than 1 hour. Two electrodes (4 or 8 contacts) were placed at sites of optimal test stimulation.

Results: Electro-acupuncture mapping revealed optimal stimulation sites far lateral to the pain area in proximity to a region where branches of the segmental rami dorsalis surface. With low stimulation intensity, a confluent field of paresthesia across the midline was observed. Lasting and additional pain relief after implantation could be seen in 14 out of 16 treated patients. The superior effect relies on 2 electrodes. Cycling stimulation ensures stable pain control. Mean pain reduction is 80%. Mean follow-up is 12 months.

Conclusions: By standardizing approach and patient selection, lumbar nerve field stimulation provided predictable and lasting pain control in our series. If our results could be reproduced in a larger trial, lumbar nerve field stimulation yields potential as a secure therapeutic option for chronic lumbar pain as a standalone therapy or in combination with SCS.