The role of spinal cord stimulation in the treatment of chronic pain postlaminectomy

Abstract

S pinal cord stimulation (SCS) has become a common and effective method of treating chronic pain, including postlaminectomy pain. However, the indications for SCS and long-term efficacy have been debated. This article discusses our experience using SCS including indications for stimulation, surgical technique, prognostic factors related to long-term success, and the results of those patients who failed trial stimulation. We compare our experience with that of other published reports and provide a section on our overall impression and criticism of the procedure and its results.

Spinal Cord Stimulation for Chronic Back and Leg Pain and Failed Back Surgery Syndrome: A Systematic Review and Analysis of Prognostic Factors

“…Moreover, the present finding that patient indication, study duration, and study setting were prognostic factors has also been shown in previous analyses undertaken at the individual case study level. 5,10,21 Implications for Further Research The present systematic review demonstrates the urgent need for additional controlled studies of SCS in patients with CBLP and FBSS as well as further investigation into those prognostic factors (both patient-and devicerelated) that might best predict the outcome of patients receiving SCS.…”

“…8 A number of patient-(e.g., age and sex) and device-related (e.g., number of electrodes) prognostic factors have been identified as being associated with the SCS outcomes of patients with CLBP and FBSS. 5,9,10 However, the lack of standardization in prognostic factors assessed, the qualitative nature of many of the analyses, and the relatively small size of studies on which these findings are based makes interpretation difficult. A rigorous statistical exploration of prognostic factors across case studies of SCS in CLBP/FBSS is therefore needed.…”

Spinal cord stimulation in 62 patients: retrospective evaluation

“…Kumar ve Toht'un da BBCS tanısı ile SKS uygulanan 182 hastalık vaka serisi mevcuttur. [8] Çalışmada BBCS nedeniyle SKS yapılan 182 hastada SKS etkinliğini değerlendirmişlerdir. Deneme sürecinde 182 hastanın 165'inde ağrı şiddetinde tatmin edici azalma görül-müş ve kalıcı sisteme geçilmiş, hastaların 8.8±4.5 yıl boyunca takiplerinde182 hastanın %48'inde ağrı şid-detinde %50 ve daha fazla azalma tespit edilmiştir.…”

Factors Affecting Outcome of Spinal Cord Stimulation in Pain Associated with Failed Back Surgery Syndrome

“…Therefore, there have been many studies which have reported the use of SCS for FBSS. However, according to Kumar and Toth [6], the long-term effect of SCS varies among studies, ranging from 40% to 70%. This suggests the longterm effect of SCS is unstable.…”

“…This study showed that patients with long intervals between the first visit to the pain clinic and SCS implantation have a tendency of poor long-term outcome with SCS. Kumar et al [6] reported that one of the prognostic factors was the interval between the first surgery and SCS implantation. The longer duration of pain affects long-term outcome of SCS.…”