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66th Annual Meeting of the German Society of Neurosurgery (DGNC)
Friendship Meeting with the Italian Society of Neurosurgery (SINch)

German Society of Neurosurgery (DGNC)

7 - 10 June 2015, Karlsruhe

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Hybrid stimulation treatment of dominant back pain patients with Precision Spectra™ system – German experience

Meeting Abstract

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  • Jaroslaw Maciaczyk - Neurochirurgische Klinik, Universitätsklinikum Düsseldorf, Deutschland
  • Athanasios Koulousakis - Klinik für Stereotaxie und Funktionelle Neurochirurgie, Universitätsklinikum Köln, Deutschland
  • Gregor Bara - Neurochirurgische Klinik, Universitätsklinikum Düsseldorf, Deutschland
  • Stefan Schu - Neurochirurgische Klinik, Universitätsklinikum Düsseldorf, Deutschland
  • Ronald Richter - Klinik für Stereotaxie und Funktionelle Neurochirurgie, Universitätsklinikum Köln, Deutschland
  • Veerle Visser-Vanderwalle - Klinik für Stereotaxie und Funktionelle Neurochirurgie, Universitätsklinikum Köln, Deutschland
  • Jan Vesper - Neurochirurgische Klinik, Universitätsklinikum Düsseldorf, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocP 085

doi: 10.3205/15dgnc483, urn:nbn:de:0183-15dgnc4834

Published: June 2, 2015

© 2015 Maciaczyk et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Although spinal cord stimulation (SCS) is an established treatment option of chronic pain in patients with a failed back surgery syndrome (FBSS), a dominant lower back pain still remains a challenge. While novel SCS systems enable better targeting, a proportion of FBSS patients do not obtain adequate pain coverage. In these cases a simultaneous epidural lead placement and subcutaneous peripheral nerve stimulation (PNS) might lead to better pain relief.

The aim of the study was to assess the efficacy of combined epidural SCS and subcutaneous PNS in pain relief of patients with dominant low back pain treated using Precision Spectra™ system in the University Hospitals of Cologne and Düsseldorf.

Method: Data was collected prospectively. The patients were implanted with either 8 contacts or 16 contact leads using a percutaneous approach under local anesthesia. After failure of the conventional SCS stimulation patients received 8 additional subcutaneous contact leads (Linear Lead 3-6™) that were connected with the pre-implanted IPG (Precision Spectra™ SCS System, USA).

Results: 5 FBSS patient suffering from dominant low back pain, after failure of conventional SCS, defined as none or negligible pain reduction, have been implanted with two or four (one patient) octrodes in the maximum pain region – mostly paramedian to the lower lumbar spine. The implantations were performed under local anesthesia and followed by a testing period. Subcutaneous leads were connected to Precision Spectra™ system, taking advantage of the multiple independent current control (MICC) technology. In all cases implantation of additional subcutaneous leads resulted in more than 50% pain reduction (median VAS decrease from 8 to 3) without increased complication risk.

Conclusions: Additional subcutaneous PNS in the region of the maximum pain using Precision Spectra™ system provides significantly better pain relief in FBSS patients, who have had none or only marginal benefit from conventional SCS. The procedure is fast and minimalyl invasive carrying no increased complication risk for the patients. Application of Precision Spectra™ system with the unique MICC technology enables simultaneous control of multiple leads with single IPG making such a "hybrid" approach feasible and cost effective.