Simultaneous Intrathecal Opioid Pump and Spinal Cord Stimulation for Pain Management: Analysis of 11 Patients With Failed Back Surgery Syndrome

Abstract

Dual-modality management of failed back surgery syndrome (FBSS) using a combination of an intrathecal opioid pump (IOP) and spinal cord stimulator (SCS) has not been investigated. The authors performed a retrospective review of 11 patients (8 men, 3 women) with FBSS who underwent nonsimultaneous surgical implantation of both an IOP and a thoracic SCS. Chart review and structured phone interviews were performed to obtain follow-up. Of the two modalities, 3 patients (27%) had an IOP placed first and 8 patients (73%) had a SCS implanted initially. Mean follow-up was 41.7 months (3-97 months). All 11 patients (100%) stated that the dual-modality treatment improved their quality of life and all continue to use both an IOP and SCS for pain control. Six patients (55%) felt that the IOP provided superior pain relief as compared to the SCS, 4 patients (36%) felt that IOP and SCS provided a similar degree of pain relief, and 1 patient (9%) said the SCS provided better pain relief than the IOP. Nine patients (82%) claimed that dual-modality treatment improved their activities of daily living. Nine patients (82%) reported that the combination of IOP and SCS treatment had allowed them to significantly decrease their oral pain medication requirements. Seven patients (64%) had hardware-related complications which required surgery; of this group, 2 patients (18%) needed more than one operation. Six patients (55%) had minor postoperative complications, which were managed nonoperatively. Overall, 10 patients (91%) were glad that they had implantation of both an IOP and SCS and would recommend this combined therapy to other patients. Dual neuroaugmentative treatment with an IOP and thoracic SCS can be safely performed and may provide satisfactory pain relief in appropriately selected patients with FBSS.

Treatment Outcomes for Patients with Failed Back Surgery

“…With this background, many clinical trials intended to relieve pain in patients with FBSS have been conducted. Various medications (11)(12)(13)(14), re-operation (15)(16)(17)(18), exercise therapy (19,20), spinal cord stimulation (SCS) (21)(22)(23)(24)(25)(26)(27)(28)(29)(30), epidural adhesiolysis (9,(31)(32)(33)(34), epidural injection (35)(36)(37), intrathecal infusion (38)(39)(40)(41) or psychotherapy (42) have been suggested as treatment options for FBSS. However, their clinical effects have not been clearly determined.…”

“…Although both studies showed decreased back pain with additional subcutaneous stimulation, they were not reliable due to the small sample size (89,90). Intrathecal infusion of opioids was also investigated and the effectiveness and safety were suggested in 2 case series (40,41). Interestingly, the usefulness of a capsaicin 8% patch was proposed (91).…”

Zygapophysial Joint Pain in Post Lumbar Surgery Syndrome. The Efficacy of Medial Branch Blocks and Radiofrequency Neurotomy

“…When a more specific diagnosis is lacking, patients with FBSS rely on pharmacological, physical, and cognitive‐behavioral therapy, but studies of these therapies specifically for FBSS are lacking . Spinal cord stimulation , intrathecal opioids , adhesiolysis , and caudal epidural injections have been used. Revision surgery is sometimes undertaken .…”

Best Practices for Minimally Invasive Lumbar Spinal Stenosis Treatment 2.0 (MIST): Consensus Guidance from the American Society of Pain and Neuroscience (ASPN)

“…Tomycz et al performed a retrospective analysis of 11 patients who were simultaneously implanted with IDDS and spinal cord stimulators (SCS). 113 While all 11 patients (100%) stated that the dual system improved their quality of life, six patients (55%) felt that their relief from the IDDS was superior to SCS. 113 Hayek et al performed a retrospective analysis of 57 patients with IDDS administration of hydromorphone and bupivacaine for postlaminectomy syndrome.…”

“… 113 While all 11 patients (100%) stated that the dual system improved their quality of life, six patients (55%) felt that their relief from the IDDS was superior to SCS. 113 Hayek et al performed a retrospective analysis of 57 patients with IDDS administration of hydromorphone and bupivacaine for postlaminectomy syndrome. 114 At 24 months, pain scores had decreased from 8.42 to 4.3 ( P <0.001).…”