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

Simultaneous spinal cord and peripheral nerve field stimulation for persistent post-herniorrhaphy pain

Meeting Abstract

  • G. Lepski - Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Tübingen, Deutschland
  • P. Vahedi - Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Tübingen, Deutschland
  • M. Tatagiba - Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Tübingen, Deutschland
  • M. Morgalla - Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Tübingen, 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. DocP 035

DOI: 10.3205/12dgnc422, URN: urn:nbn:de:0183-12dgnc4229

Published: June 4, 2012

© 2012 Lepski 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 post hernia pain is a common complication after inguinal herniorrhaphies. Perpheral nerve field stimulation (PNFS) and spinal cord stimulation (SCS) are two new promising treatment modalities. Four patients with persistent neuropathic post-hernia pain were recruited for this prospective study.

Methods: Simultaneous electrodes were inserted into the epidural space of the spinal canal and into the subcutaneous tissue in the inguinal region (Octrode and Quatrode, respectively, St. Jude Medical). During a 14-day trial, double blind stimulation was performed via an external stimulator; 3 days over the spinal electrode, 3 days over the inguinal electrode, 3 days over both, and 5 days off, with an alternating order from patient to patient. During the trial, pain intensity was assessed thrice daily by the visual analogue scale. Additionally, pain intensity and quality of life (QOL) were assessed before and after surgical intervention by the Brief Pain Inventory, SF36 scale and the Pain Disability Index.

Results: All patients had a marked pain reduction during the trial phase, and this reduction was more prominent when both electrodes were activated simultaneously (p<0.001). At the late follow-up, a significant pain reduction and improvement of QOL was observed in 3 patients.

Conclusions: Both SCS and PNFS are effective in treating post-hernia pain, but the magnitude of pain reduction was more prominent with concomitant stimulation. Simultaneous PNFS and SCS should be considered for patients with a less than optimum response to either SCS or PNFS. More studies are necessary to address the cost-effect issues of this new approach to treatment.