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

Automatic adaptation of stimulation intensity for spinal cord stimulation in cases of body position-dependent different stimulation levels

Meeting Abstract

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  • D. Rasche - Klinik für Neurochirurgie, Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
  • V.M. Tronnier - Klinik für Neurochirurgie, Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland

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.11.02

DOI: 10.3205/12dgnc256, URN: urn:nbn:de:0183-12dgnc2563

Published: June 4, 2012

© 2012 Rasche et al.
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Outline

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Objective: Spinal cord stimulation (SCS) is an evidence-based treatment option in patients with chronic radicular neuropathic pain following spinal surgery, e.g. after lumbar herniotomy. At the beginning of treatment, percutaneous leads are usually placed at the thoracolumbar epidural space. About two-thirds of the patients report unpleasant stimulation and movement-related change of stimulation effects and the need for manual adaptation of the stimulation intensity. We report on our clinical experience with an integrated sensory device for automatic stimulation intensity adaptation in correlation to a changing body position.

Methods: The new neurostimulator was implanted in 15 patients (8 women, 7 men; mean age: 49 years, range: 33–62) after a positive SCS trial (14) or as an exchange in one patient with battery depletion. The mean follow-up was 8 months (range: 3–18 months). Programming and activation of the automatic adaptation mode was performed between 2 and 8 weeks after implantation. At least two follow-up controls were conducted and the data of the stimulation diary, recorded in the device, analysed.

Results: The mean amplitude for SCS in the horizontal position was 5.0 V (2.9–7.1 V) and 7.7 V (5.8–9.5 V) in the upright position with a mean difference of 2.7 V. Effective pain reduction was achieved in 14/15 patients and the automatic adaptation was successful and very well accepted by the patients. In 2 patients, a reprogramming after 2–4 weeks was necessary. In one patient the device was explanted after 4 months because of loss of the SCS-effect and the wish of the patient. Analysing the neurostimulator diary data of 10 patients revealed, that despite pain reduction, no significant change of daily activity was found (p > .05).

Conclusions: The automatic adaptation and adjustment of SCS intensity in cases with body position-dependent different stimulation intensities is a reliable tool and leads to an improvement of the acceptance of therapy and increased comfort and quality of life of these patients. The indication for this device is recommended for patients with differences of more than 2.0 V in different body positions and a good effect, acceptance and compliance with the SCS therapy. Further development of this technique and the next generation of these sensory devices should be implemented in all kind of neurostimulators for SCS.