gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Feasibility, safety and efficacy of Subcutaneous Peripheral Nerve Field Stimulation (sPNS) for the treatment of refractory low back pain. Two-year single-center results

Meeting Abstract

  • Basem Ishak - Universitätsklinikum Heidelberg, Heidelberg, Deutschland
  • Heike Brunn - Heidelberg, Deutschland
  • Sigrid Schuh-Hofer - Mannheim, Deutschland
  • Andreas Unterberg - Heidelberg, Deutschland
  • Rezvan Ahmadi - Heidelberg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMi.06.04

doi: 10.3205/17dgnc397, urn:nbn:de:0183-17dgnc3971

Published: June 9, 2017

© 2017 Ishak 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: 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.

Methods: 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. Visual analog scale (VAS), Oswestry Disability Index (ODI) and quality of life (EQ-5D) were measured preoperative and at 6- and 24-months follow-up.

Results: Out of 26 patients 13 had a permanent neurostimulator implantation after a successful trial. The pain medication including opioid analgesics could be reduced in 92 % of patients after 24 months. In those patients we demonstrated a significant improvement of VAS, ODI and EQ-5D at 6-months, which deteriorated in three patients at 24-months follow-up without significant difference to the 6-months results. In two patients the preoperative marked pain area increased by half after 24 months. The complication rate was 23 % (3 of 13, hardware failure, electrode dislocation and silicone intolerance) and is comparable to published data. Concerning the non-responder (13 patients) we could find a high correlation to posterior lumbar stabilization in three or more levels.

Conclusion: 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.