gms | German Medical Science

Objective: Over decades spinal cord stimulation (SCS) with conventional (tonic) waveforms is known as a treatment option for chronic leg pain with the aim to cover the painful area with comfortable paresthesia to reduce pain. During the last years a variety of innovative waveforms were evolved. High-frequency stimulation using 10 kHz (HF10) decreases chronic low back and leg pain, significantly. For the therapy of patients suffering from both, chronic low back and leg pain as well as chronic neck and upper limb pain, we implant one electrode at TH9/TH10 level and the second in the cervical epidural space. In a retrospective study we evaluated the efficacy and safety of cervical HF10-SCS for the management of chronic low back pain.

Methods: Between July 2015 and October 2018 17 patients (8 female/9 male) with chronic neck and upper limb pain as well as chronic low back and leg pain were implanted with 2 eight-contact electrodes (octrodes), one in the cervical epidural space (tip of the electrode ranged from C2-C3) and the other one covering the area between TH9 and TH10. During the trial period the patients were tested for two weeks via an external neurostimulator. Each octrode alone was activated for one week and the patients were blinded due to the activated octrode. The response was documented by a daily pain diary using the Visual Analog Scale (VAS) for every painful area. The indication to implant the permanent neurostimulator (IPG) was fulfilled with a pain reduction of ≥50%. In this study the effect of the cervical stimulation on low back pain was evaluated.

Results: At baseline the patients rated their low back pain level with median 8,0±0,9 on the VAS and after the cervical high-frequency stimulation with 4,0±2,6. 13 of the patients had a pain reduction of more than 50% during this trial period, which is reflected by a median VAS of 3,0±1,3. One mentioned a lower decrease of pain and 3 of them did not respond at all. These 4 patients described a decrease of more than 50% using both octrodes in combination. All patients were stimulated between C2 and C4-level. No patient reported on stimulation related discomfort or paresthesia.

Conclusion: Our study shows that 10 kHz cervical spinal cord stimulation can reduce chronic low back pain significantly. Prospective studies are needed to examine if this could offer an alternative option for patients not responding to thoracic HF10-SCS and thus may be able to minimize the number of failed trials.