gms | German Medical Science

Objective: Chronic low back pain is challenging to treat, especially in patients with multiple spine surgeries. Minimal invasive neurostimulation therapies, such as sPNS, have been introduced to improve pain relief, quality of life and functional capacity when conservative treatment and medical management have failed. However, the interest in sPNS has been increasing over the past few years. At present no clear guidelines exist for indication, use and follow-up of this system. The goal of our study was to assess usefulness, safety and efficacy of sPNS in patients with chronic low back pain.

Method: 26 consecutive patients with chronic low back pain who had failed conservative treatment for at least 6 months were prospectively included in our study. Two electrodes were implanted in the subcutaneous tissue at a depth of 1 cm vertically with a maximum distance of 10 cm to each side in the region of maximum pain, as identified by each individual patient. All patients have had a 14 day trial of stimulation with electrodes connected to an external neurostimulator to assess response. A minimum of 50 % pain relief was required for implantation of the permanent neurostimulator system. Demographics, pain levels using visual analogue scale (VAS) for low back pain and oral pain medication were evaluated with a 6-months follow-up.

Results: Out of 26 patients 13 had a permanent neurostimulator implantation after a successful trial. In those patients we demonstrated an average pain reduction of over 80% measured by VAS, which was given for at least 6 months. Pain relief was significantly and highly correlated with reduced analgesic intake and patient satisfaction. The pain medication including opioid analgesics could be reduced in 92 % of patients. Therefore vertically/axially-orientated electrodes seem to provide an effective treatment option. The complication rate was 23 % (3 of 13, hardware failure, electrode dislocation and wound infection) and is comparable to published data.

Conclusions: sPNS is a novel, safe and effective procedure for the treatment of chronic low back pain and may provide advantages over interventional treatments including intrathecal therapy and spinal cord stimulation. Further prospective data collection is necessary to establish guidelines for recommended use.