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

Abstract

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.

Neural Stimulation and Molecular Mechanisms of Plasticity and Regeneration: A Review

“…Importantly, it is not currently feasible to target specific motor pools via dorsal ES. In fact, it is likely that ES preferentially activates central pattern generator circuitry, which limits its therapeutic potential (Bareyre et al, 2004 ; Taccola et al, 2017 ) Conversely, scarring and functional stability are major barriers for clinical translation of intraparenchymal stimulation techniques, whereas ES has been widely applied in the clinic with favorable outcomes (Stidd et al, 2014 ).…”

Are there guidelines for implantable spinal cord stimulator therapy in patients using chronic anticoagulation therapy? - A review of decision-making in the high-risk patient

“…A case series found that 89% (eight out of nine) of patients had >50% relief of chronic axial LBP with a mean follow-up of 19.9 months after SCS implantation. [ 34 ] As mentioned above, we believed our patient would gain relief from surgical decompression using a laminectomy and that a surgical paddle lead would provide a palliative pain control of chronic LBP and leg pain as a result of FBSS. Even so, laminectomy or laminotomy is an invasive procedure, and the benefits of surgical paddle leads are gained with durable pain coverage and reduced likelihood of lead migration.…”

Use of Spinal Cord Stimulation in Elderly Patients with Multi-Factorial Chronic Lumbar and Non-Radicular Lower Extremity Pain

“…Studies show slightly more morbidity with paddle leads but better short-term results. However, long-term follow-up at three years shows similar outcomes [ 15 , 16 ]. The results of spinal cord stimulation for FBSS can be affected by the experience and specialty of the implanter [ 17 ].…”

“…The results of spinal cord stimulation for FBSS can be affected by the experience and specialty of the implanter [ 17 ]. Using a single lead targeting primarily axial lumbar pain may not provide sufficient stimulation coverage for patients who also have peripheral neuropathic pain affecting the lower legs and feet or lateralized pain after joint replacement [ 14 , 16 , 18 ]. Most battery systems allow the use of two leads which provides the ability to place two separate electrode arrays, one targeting the axial lumbar spine pain and the other targeting the peripheral neuropathic pain or more lateral joint pain.…”