Article
Spinal cord stimulation – a reasonable alternative treatment in patients with symptomatic adult scoliois if surgical therapy is not suitable?
Spinal Cord Stimulation – eine alternative Therapie bei symptomatischer adulter Skoliose, wenn die Operation nicht geeignet ist?
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Authors
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Kristin Lucia
- Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
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Stefan Nulis
- Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
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Dimitri Tkatschenko
- Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
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Anja Kuckuck
- Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
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Peter Vajkoczy
- Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
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Simon Bayerl
- Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: In adult scoliosis the asymmetric loading of weight-bearing structures promotes progressive degeneration causing lower back pain (LBP) and additional regional pain (RP). For patients who do not respond to conservative therapy dorsal instrumentation and fusion can provide significant improvement of pain and impairment scores, however complication rates of up to 39% have been reported. We therefore we aimed to evaluate the use of neuromodulation, in particular spinal cord stimulation (SCS), in a larger cohort of adult scoliosis patients.
Methods: We prospectively analyzed 18 adult scoliosis patients receiving SCS treatment in our institution between February 2019 and May 2020. Adult scoliosis was defined as a Cobb angle of >10° in the coronal plane in skeletally mature patients. Clinical follow-up was performed at 3,6 and 12 months following implantation of an epidural SCS System. Patients reported NRS values for the categories of LBP and specific regional pain both at rest and in motion. Further, Short form-36, Short form of the Profile of Mood States, Pittsburgh Sleep Quality Index and Oswestry Disability Index were collected. The study was approved by the institutional Ethics Committee (EA2/093/13).
Results: The average patient age was 71 years old (range 33-85) with a BMI of 29 kg/m2 (range 22-37 kg/m2). Scoliotic deformity of the thoracolumbar junction was most commonly reported (66%). Compared to preoperative values, NRS of lower back pain (LBP) at rest was significantly reduced following SCS at three (43% lower, p=0.005) and six (49% lower, p=0.027) months follow-up. LBP in motion was also reduced at three (32% lower, p=0.005) and six (36% lower, p=0.010) months. RP at rest was reduced at three (42% lower, p=0.002) and six (52% lower, p=0.014) and in movement at three (29% lower, 0.004) and six (34% lower, p=0.012). Sleep quality and symptoms of depression were significantly improved at 3 months after implantation, and disability scores improved significantly at six months following implantation.
Conclusion: Our cohort was comprised of adults for whom the risks of corrective surgery must be carefully considered. In these patients, neuromodulation can significantly reduce LBP as well as RP in the first six months following implantation indicating that neuromodulation may provide a reasonable alternative in poor surgical candidates.
