Spinal Cord Stimulation versus Reoperation for Failed Back Surgery Syndrome: A Cost Effectiveness and Cost Utility Analysis Based on a Randomized, Controlled Trial

North, Richard B.; Kidd, David H.; Shipley, Jane; Taylor, Rod S

doi:10.1227/01.neu.0000255522.42579.ea

Cited by 267 publications

(193 citation statements)

References 28 publications

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“…18 Levy and coworkers 13 performed a nationwide study on neurological complications after using surgical paddles for SCS across all indications; the study involved about 44,857 patients. The rare complication for a spinal epidural hematoma (EDH) was observed in 0.19% of patients, two-thirds of whom exhibited substantial motor deficit.…”

Section: Discussionmentioning

confidence: 99%

Complications related to the use of spinal cord stimulation for managing persistent postoperative neuropathic pain after lumbar spinal surgery

Shamji

Westwick

Heary

2015

FOC

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OBJECT Structural spinal surgery yields improvement in pain and disability for selected patients with spinal stenosis, spondylolisthesis, or a herniated intervertebral disc. A significant fraction of patients exhibit persistent postoperative neuropathic pain (PPNP) despite technically appropriate intervention, and such patients can benefit from spinal cord stimulation (SCS) to alleviate suffering. The complication profile of this therapy has not been systematically assessed and, thus, was the goal of this review. METHODS A comprehensive literature search was performed to identify prospective cohorts of patients who had PPNP following structurally corrective lumbar spinal surgery and who underwent SCS device implantation. Data about study design, technique of SCS lead introduction, and complications encountered were collected and analyzed. Comparisons of complication incidence were performed between percutaneously and surgically implanted systems, with the level of significance set at 0.05. RESULTS Review of 11 studies involving 542 patients formed the basis of this work: 2 randomized controlled trials and 9 prospective cohorts. Percutaneous implants were used in 4 studies and surgical implants were used in 4 studies; in the remainder, the types were undefined. Lead migration occurred in 12% of cases, pain at the site of the implantable pulse generator occurred in 9% of cases, and wound-related complications occurred in 5% of cases; the latter 2 occurred more frequently among surgically implanted devices. CONCLUSIONS Spinal cord stimulation can provide for improved pain and suffering and for decreased narcotic medication use among patients with PPNP after lumbar spinal surgery. This study reviewed the prospective studies forming the evidence base for this therapy, to summarize the complications encountered and, thus, best inform patients and clinicians considering its use. There is a significant rate of minor complications, many of which require further surgical intervention to manage, including lead migration or implant infection, although such complications do not directly threaten patient life or function.

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Section: Discussionmentioning

confidence: 99%

Complications related to the use of spinal cord stimulation for managing persistent postoperative neuropathic pain after lumbar spinal surgery

Shamji

Westwick

Heary

2015

FOC

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“…In a third-party review of the first 42 patients in a separate, randomized, controlled, crossover trial comparing SCS with reoperation in patients with failed back surgery syndrome, North et al 20 concluded that SCS was ''less expensive and more effective than reoperation in selected patients and should be the initial therapy of choice. ' …”

Section: A Systematic Review Concluded That There Is Level Ii-1 or IImentioning

confidence: 99%

Managing Chronic Pain With Spinal Cord Stimulation

Epstein

Palmieri

2012

Mount Sinai J Medicine

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Since its introduction as a procedure of last resort in a terminally ill patient with intractable cancer‐related pain, spinal cord stimulation has been used to effectively treat chronic pain of varied origins. Spinal cord stimulation is commonly used for control of pain secondary to failed back surgery syndrome and complex regional pain syndrome, as well as pain from angina pectoris, peripheral vascular disease, and other causes. By stimulating one or more electrodes implanted in the posterior epidural space, the patient feels paresthesias in their areas of pain, which reduces the level of pain. Pain is reduced without the side effects associated with analgesic medications. Patients have improved quality of life and improved function, with many returning to work. Spinal cord stimulation has been shown to be cost effective as compared with conservative management alone. There is strong evidence for efficacy and cost effectiveness of spinal cord stimulation in the treatment of pain associated with intractable angina, failed back surgery syndrome, and complex regional pain syndrome. In this article, we review the history and pathophysiology of spinal cord stimulation, and the evidence (or lack thereof) for efficacy in common clinical practice. Mt Sinai J Med 79:123–132, 2012. © 2012 Mount Sinai School of Medicine

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“…The therapy has been demonstrated to be more effective than repeat back surgery and medication management in the control of pain [18,19]. Traditional or tonic stimulation has been used since the 1960s and is a widely accepted approach to managing neuropathic pains.…”

Section: Spinal Cord Stimulationmentioning

confidence: 99%

Alternatives to Opiates in the Management of Non-cancer-related Pain

Staats

Silverman

2016

Controlled Substance Management in Chronic Pain

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Spinal Cord Stimulation versus Reoperation for Failed Back Surgery Syndrome: A Cost Effectiveness and Cost Utility Analysis Based on a Randomized, Controlled Trial

Abstract: SCS was less expensive and more effective than reoperation in selected failed back-surgery syndrome patients, and should be the initial therapy of choice. SCS is most cost-effective when patients forego repeat operation. Should SCS fail, reoperation is unlikely to succeed.

Cited by 267 publications

References 28 publications

Complications related to the use of spinal cord stimulation for managing persistent postoperative neuropathic pain after lumbar spinal surgery

Complications related to the use of spinal cord stimulation for managing persistent postoperative neuropathic pain after lumbar spinal surgery

Managing Chronic Pain With Spinal Cord Stimulation

Alternatives to Opiates in the Management of Non-cancer-related Pain

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