Spinal Cord Stimulation for Axial Low Back Pain

North, Richard B.; Kidd, David H.; Olin, John; Sieracki, Jeffrey M.; Farrokhi, Farrokh; Petrucci, Loredana; Cutchis, Protagoras N.

doi:10.1097/01.brs.0000166502.05449.a8

Cited by 139 publications

(15 citation statements)

References 37 publications

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“…Axial LBP pain, on the other hand, has been difficult to treat with SCS alone,1,2,4,8–12 possibly due to the nociceptive origin of the axial spine pain. Vascularized granulation tissue, for example, has been found to be associated with chronic lumbar disc disease and histologically contains nociceptors that may be the cause of the nociceptive nature of isolated LBP in this population 17.…”

Section: Discussionmentioning

confidence: 99%

“…Placement of three individual percutaneously placed linear leads creating a tripolar configuration, for instance, was shown to benefit a single case of FBSS utilizing a guarded cathode arrangement 19. Several larger case series studies demonstrate improved axial LBP with SCS using various configurations of percutaneously placed leads 12,20–22…”

Section: Discussionmentioning

confidence: 99%

“…Clinical series report between 50% to 70% successful pain relief in patients treated with SCS based on reduction in pain severity scores, improvement in function, and decreased pain medication dependence 1–7. Until recently, SCS has been considered relatively ineffective for treatment of chronic axial low back pain (LBP) 1,2,4,8–12. Most clinical series report better pain control with SCS in patients with lower extremity (LE) radicular pain than in patients with isolated, axial LBP,1,13 an expected finding based on functional neuroanatomy.…”

Section: Introductionmentioning

confidence: 99%

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Spinal cord stimulation with implanted epidural paddle lead relieves chronic axial low back pain

Stidd

Rivero

Weinand

2014

JPR

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IntroductionSpinal cord stimulation (SCS) provides significant relief for lumbosacral radiculopathy refractory to both medical and surgical treatment, but historically only offers limited relief for axial low back pain (LBP). We aim to evaluate the response of chronic axial LBP treated with SCS using a surgically implanted epidural paddle lead.Materials and methodsThis is a retrospective review of a consecutive series of patients with exclusive LBP or predominant LBP associated with lower extremity (LE) pain evaluated and treated with SCS using an implanted paddle lead within the dorsal thoracic epidural space. Baseline LBP, and if present LE pain, were recorded using the visual analogue scale (VAS) at an initial evaluation. At a follow-up visit (a minimum of 12 months later), LBP and LE pain after a spinal cord stimulator implantation were again recorded using the VAS. Patients were also asked to estimate total LBP pain relief achieved.ResultsPatients with either exclusive (n=7) or predominant (n=2) axial LBP were treated with SCS by implantation of a paddle lead at an average spine level of T9. The baseline VAS score for LBP was 7.2; after a follow-up of 20 months, the score decreased to 2.3 (P=0.003). The LE pain VAS score decreased from 7.5 to 0.0 (P=0.103). Patients also reported a subjective 66.4% decrease of their LBP at follow-up. There were no surgical complications.ConclusionsAxial LBP is refractory to many treatments, including SCS. SCS using a surgically implanted paddle electrode provides significant pain relief for chronic axial LPB, and is a safe treatment modality.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Spinal cord stimulation with implanted epidural paddle lead relieves chronic axial low back pain

Stidd

Rivero

Weinand

2014

JPR

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“…Other prospective studies have compared percutaneous to laminectomy electrodes [99] and dual-lead to single-lead systems [98], and multiple case series have reported favorable outcomes with SCS in FBSS. The results of the RCTs summarized above and these studies [100] support a weak recommendation.…”

Section: Radiculopathy and Failed Back Surgery Syndromementioning

confidence: 99%

Interventional management of neuropathic pain: NeuPSIG recommendations

Dworkin

O’Connor

Kent

et al. 2013

Pain

395

288

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Neuropathic pain (NP) is often refractory to pharmacologic and non-interventional treatment. On behalf of the International Association for the Study of Pain Neuropathic Pain Special Interest Group (NeuPSIG), the authors evaluated systematic reviews, clinical trials, and existing guidelines for the interventional management of NP. Evidence is summarized and presented for neural blockade, spinal cord stimulation (SCS), intrathecal medication, and neurosurgical interventions in patients with the following peripheral and central NP conditions: herpes zoster and postherpetic neuralgia (PHN); painful diabetic and other peripheral neuropathies; spinal cord injury NP; central post-stroke pain; radiculopathy and failed back surgery syndrome (FBSS); complex regional pain syndrome (CRPS); and trigeminal neuralgia and neuropathy. Due to the paucity of high-quality clinical trials, no strong recommendations can be made. Four weak recommendations based on the amount and consistency of evidence, including degree of efficacy and safety, are: (1) epidural injections for herpes zoster; (2) steroid injections for radiculopathy; (3) SCS for FBSS; and (4) SCS for CRPS type 1. Based on the available data, we recommend not to use sympathetic blocks for PHN nor RF lesions for radiculopathy. No other conclusive recommendations can be made due to the poor quality of available of data. Whenever possible, these interventions should either be part of randomized clinical trials or documented in pain registries. Priorities for future research include randomized clinical trials; long-term studies; and head-to-head comparisons among different interventional and non-interventional treatments.

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“…6,7 Commercial SCS with implantable batteries are expensive to develop, test, and implant and often involve complex programming methods and increasingly invasive procedures. 4,[8][9][10] A wirelessly powered, injectable SCS addresses many current procedural problems by eliminating the implantable pulse generator (IPG) and relocating the functionality outside of the body. With this design, the procedure time is drastically reduced as there is no need for tunneling or IPG pocket surgery.…”

Section: Introductionmentioning

confidence: 99%