Artikel
High-frequency spinal cord stimulation for lower back pain in surgery naïve patients
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Autoren
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Sebastian A. Ahmadi
- Department of Functional Neurosurgery and Stereotaxy, Heinrich-Heine University, Düsseldorf, Germany
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Jan Vesper
- Department of Functional Neurosurgery and Stereotaxy, Heinrich-Heine University, Düsseldorf, Germany
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Stefan Schu
- Department of Functional Neurosurgery and Stereotaxy, Heinrich-Heine University, Düsseldorf, Germany
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Philipp J. Slotty
- Department of Functional Neurosurgery and Stereotaxy, Heinrich-Heine University, Düsseldorf, Germany
| Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: A multitude of evidence supporting the beneficial effects of spinal cord stimulation (SCS) in patients suffering from chronic pain syndromes following spinal surgery has been published in the last decade. Evidence is scarce however for the use of high frequency SCS (HFSCS) in the treatment of surgery naïve patients suffering from lower back pain (LBP).
Method: From June 2014 to March 2015 we prospectively enrolled patients suffering from LBP alone or in conjunction with leg pain in a trial of HFSCS. None of the patients had undergone surgical procedures of the thoracic, lumbar or sacral spine. Patients suffered medically intractable LBP and were deemed ineligible for spine surgery due to mismatches in imaging findings and clinical symptoms, or were medically unfit to undergo extensive surgical procedures. All patients underwent trial stimulation for at least one week. IPG implantation was conducted only following successful trials, i.e. at least 50% pain reduction on the VAS. Pain levels were assessed daily during initial stay, 4 weeks later and then every 3 months. Different pre-programmed modes of HFSCS were changed if pain persisted or increased during trial or post-implant follow-up.
Results: A total of 7 patients (4 male, 3 female) underwent HFSCS trials. Mean age was 61 years. Mean baseline intensity for back pain was 8.86/10 ± 0.26, and for leg pain 8.10 ± 0.60. All patients achieved significant reductions in pain intensities and underwent IPG implantation at a mean interval of 13 ± 1.5 days. Total follow-up time after IPG implant is ongoing and currently ranges from 49 to 311 days (mean 179 ± 38 days). Mean back pain VAS reduction from baseline at last follow-up was -4.43 ± 1.05, and -6.5 ± 0.89 for leg pain. One patient had signs of a delayed wound infection with redness and pain at the IPG implantation site. IPG was replanted and microbiology results were sterile, thus no case of infection was noted in this study population.
Conclusions: In this prospective cohort of surgery naïve patients we were able to show good efficacy of HFSCS for both back and leg pain. Reductions were long-lasting with a mean follow-up of nearly 6 months in our cohort, and a mean VAS reduction at last follow-up of 4.43 and 6.5 for back and leg pain, respectively.
