Spinal Cord Stimulation for Acute Pain Following Surgery for Cervical Myelopathy: A Novel Treatment Strategy

McLean, Aaron Lawson; Kalff, Rolf; Reichart, Rupert

doi:10.1111/papr.12742

Cited by 6 publications

(3 citation statements)

References 51 publications

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“…SCS has shown its effectiveness on chronic pain in patients with FBSS. 30–34 Although there is a report that a neuromodulation technique has a strong positive effect on acute postoperative pain, 35 to the best of our knowledge, the intraoperative use of SCS is the novel strategy to control acute postoperative pain after spine surgery.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Spinal Cord Stimulation Mitigates Pain after Spine Surgery in Mice

Yamamoto

Duong

Kim

et al. 2022

Preprint

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Background: Managing postoperative pain after spine surgery is challenging, and up to 40% of operated patients develop failed back surgery syndrome (FBSS) resulting in intractable back and/or leg pain. While spinal cord stimulation (SCS) has been shown to effectively alleviate such chronic pain, it is unknown if intraoperative SCS can mitigate the development of central sensitization that potentially causes intense postoperative pain and FBSS after spine surgery. Methods: As an experimental spine surgery, unilateral T13 laminectomy was performed in mice to expose the dorsal part of L4-5 spinal segments that receive sensory inputs from the hind limb. After the laminectomy, a group of mice received intraoperative SCS epidurally applied to the exposed side of the dorsal part of the spinal cord for an hour under anesthesia before closing the surgical wounds. Secondary mechanical hypersensitivity, a behavioral manifestation of central sensitization, was measured in hind paws using von Frey assay one day before and at predetermined times after surgery. In addition, because von Frey assay is a nocifensive reflex-based analysis that primarily assesses the sensory-discriminative domain of pain, we also performed a conflict avoidance test to capture the affective-motivational domain of pain at selected timepoints post-laminectomy. Results: Mice that underwent unilateral T13 laminectomy developed mechanical hypersensitivity in both hind paws, which gradually resolved in 1-2 weeks. The extent of the hypersensitivity was significantly less in the contralateral hind paw (relative to the laminectomy) than in the ipsilateral hind paw only in females. Intraoperative SCS applied to the exposed side of the dorsal -spinal cord significantly inhibited the development of hind paw mechanical hypersensitivity only in the SCS-applied side. When paws were mechanically stimulated in their preferred place to present a conflict between pain/discomfort and natural preference, mice avoided the conflict after laminectomy, spending less time in the place than before the surgery. However, mice treated with intraoperative SCS after laminectomy did not avoid the conflict. Conclusion: These results demonstrate that spine surgery for unilateral laminectomy induces central sensitization that results in postoperative pain hypersensitivity. Intraoperative SCS after laminectomy can mitigate the development of this hypersensitivity on the SCS-applied side.

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Section: Discussionmentioning

confidence: 99%

Intraoperative Spinal Cord Stimulation Mitigates Pain after Spine Surgery in Mice

Yamamoto

Duong

Kim

et al. 2022

Preprint

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“… 118 , 119 There is limited evidence for the use of SCS for pain in DCM but one case study of a cervical spinal cord stimulator placed (C3-C6) for significant post-operative pain following posterior decompression (C5-C7), resulting in a significant reduction in pain. 120 Of note, the efficacy of SCS for SCI-induced pain appears to be more limited when compared to the aforementioned indications, such as FBSS, which may be due to the significant damage to underlying neural circuits required for the analgesic effects of SCS. 121 , 122 …”

Section: Neuromodulationmentioning

confidence: 99%

Developing Novel Therapies for Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 7]: Opportunities From Restorative Neurobiology

Gharooni

Fehlings

Boerger

et al. 2022

Global Spine Journal

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Study design Narrative review. Objectives To provide an overview of contemporary therapies for the James Lind Alliance priority setting partnership for degenerative cervical myelopathy (DCM) question: ‘Can novel therapies, including stem-cell, gene, pharmacological and neuroprotective therapies, be identified to improve the health and wellbeing of people living with DCM and slow down disease progression?’ Methods A review of the literature was conducted to outline the pathophysiology of DCM and present contemporary therapies that may hold therapeutic value in 3 broad categories of neuroprotection, neuroregeneration, and neuromodulation. Results Chronic spinal cord compression leads to ischaemia, neuroinflammation, demyelination, and neuronal loss. Surgical intervention may halt progression and improve symptoms, though the majority do not make a full recovery leading to lifelong disability. Neuroprotective agents disrupt deleterious secondary injury pathways, and one agent, Riluzole, has undergone Phase-III investigation in DCM. Although it did not show efficacy on the primary outcome modified Japanese Orthopaedic Association scale, it showed promising results in pain reduction. Regenerative approaches are in the early stage, with one agent, Ibudilast, currently in a phase-III investigation. Neuromodulation approaches aim to therapeutically alter the state of spinal cord excitation by electrical stimulation with a variety of approaches. Case studies using electrical neuromuscular and spinal cord stimulation have shown positive therapeutic utility. Conclusion There is limited research into interventions in the 3 broad areas of neuroprotection, neuroregeneration, and neuromodulation for DCM. Contemporary and novel therapies for DCM are now a top 10 priority, and whilst research in these areas is limited in DCM, it is hoped that this review will encourage research into this priority.

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“…SCS has shown its effectiveness in chronic pain in patients with FBSS. [33][34][35][36][37] Although there is a report that a neuromodulation technique has a strong positive effect on acute postoperative pain, 38 to the best of our knowledge, the intraoperative use of SCS is a novel strategy to control acute postoperative pain after spine surgery.…”

mentioning

confidence: 99%

Intraoperative Spinal Cord Stimulation Mitigates Central Sensitization After Spine Surgery in Mice

Yamamoto

Duong

Kim

et al. 2023

Spine

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Double-blinded, prospective laboratory animal study. Objective. To examine whether intraoperative spinal cord stimulation (SCS) inhibits the development of spine surgery-induced hypersensitivity. Summary of Background Data. Managing postoperative pain after spine surgery is challenging, and as many as 40% of patients may develop failed back surgery syndrome. Although SCS has been shown to effectively reduce chronic pain symptoms, it is unknown whether intraoperative SCS can mitigate the development of central sensitization that causes postoperative pain hypersensitivity and potentially leads to failed back surgery syndrome after spine surgery. Materials and Methods. Mice were randomly stratified into three experimental groups: (1) sham surgery, (2) laminectomy alone, and (3) laminectomy plus SCS. Secondary mechanical hypersensitivity was measured in hind paws using von Frey assay one day before and at predetermined times after surgery. In addition, we also performed a conflict avoidance test to capture the affective-motivational domain of pain at selected time points postlaminectomy.Results. Mice that underwent unilateral T13 laminectomy developed mechanical hypersensitivity in both hind paws. Intraoperative SCS applied to the exposed side of the dorsal spinal cord significantly inhibited the development of hind paw mechanical hypersensitivity on the SCS-applied side. Sham surgery did not produce any obvious secondary mechanical hypersensitivity in the hind paws. Conclusions. These results demonstrate that spine surgery for unilateral laminectomy induces central sensitization that results in postoperative pain hypersensitivity. Intraoperative SCS after laminectomy may be able to mitigate the development of this hypersensitivity in appropriately selected cases.

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Spinal Cord Stimulation for Acute Pain Following Surgery for Cervical Myelopathy: A Novel Treatment Strategy

Cited by 6 publications

References 51 publications

Intraoperative Spinal Cord Stimulation Mitigates Pain after Spine Surgery in Mice

Intraoperative Spinal Cord Stimulation Mitigates Pain after Spine Surgery in Mice

Developing Novel Therapies for Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 7]: Opportunities From Restorative Neurobiology

Intraoperative Spinal Cord Stimulation Mitigates Central Sensitization After Spine Surgery in Mice

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