2019 FSA Posters
P047: HIGH FREQUENCY SPINAL CORD STIMULATOR THERAPY FOR FAILED BACK SURGERY SYNDROME
Cara Esser, MD, Neeraj Nanavati, MD, William Grubb, MD, DDS; Rutgers Robert Wood Johnson
Introduction: Back pain is a prominent condition worldwide with 9.4% global incidence, more disability than any other condition. Failed back surgery syndrome (FBSS) consists of patients that have longstanding back pain with or without radicular symptoms and have had one or more surgical procedures without alleviation of pain¹. High frequency spinal cord stimulation (HF SCS) therapy is a treatment modality that has shown excellent management of FBSS¹. In this example, a 49 y/o male referred for SCS re-implant. Had history of multiple spine surgeries for cervical and lumbar radiculopathies and multiple interventional procedures including epidurals, facet injections, trigger point injections and RFAs. These provided minimal relief of his pain. Previously he had low frequency SCS that improved his pain; however, it became infected and was explanted. Continued to complain of neck pain with radiation to LUE and associated weakness and tingling as well as back pain with radiation to LE bilaterally associated with numbness/tingling.
A 5 day trial of HF SCS was proposed, 2 thoracic lead placement here was implemented and resulted in reduction of patient’s pain as well as improved function.
Methods: Patient consented for procedure, taken to OR and placed in prone position. Pressure points supported, and sedation was given. Clindamycin IV antibiotic given and lumbar region was sterilely prepped. A 14-gauge Tuohy epidural needle was advanced via paramedian approach under fluoroscopic guidance until loss of resistance was achieved and confirmed at T10 level. This technique was utilized for all lead placements. The leads were placed on left top T7 vertebral body and on right top T8. Verified with fluoroscopy. Neurosurgical team implanted the stimulator battery; leads were connected to the generator and placed in pocket of right iliac crest. Acceptable impedence of leads was confirmed prior to anchoring and attachment of the leads to the generator. Figures 1 and 2 demonstrate patient’s leads in place.
Results: One month post-op from re-implant of SCS, he had 75% relief of his pain on left side and 50% on right side. Reprogramming of the stimulator has been ongoing for continued improvement of patient’s pain.
Discussion: Analgesia because of SCS is due to its effects on spinal cord as well as supraspinal components of the CNS and inducing descending inhibitory pathways. The Prospective Randomized Controlled Multicenter Trial showed improved outcomes in patients with FBSS by SCS in comparison with conventional medical treatment. The PRECISE Study demonstrated SCS would be cost effective in 80-85% when adjusted for quality-adjusted life years¹. SCS has proven effective in alleviating chronic back pain that has been refractory to other modalities including surgery and conservative therapy. Advantages of SCS include decreased morbidity in comparison to repeat lumbar surgery and greater reduction in pain postoperatively². SCS has shown to provide exceptional outcomes in patients with FBSS².
References:
1: Baber, Zafeer and Michael A Erdek. “Failed Back Surgery Syndrome: Current Perspectives.” J Pain Res. 2016; 9: 979-987.
2: Nissen, Mette et al. “Long-Term Outcome of Spinal Cord Stimulation in Failed Back Surgery Syndrome.” Neurosurgery. May 2018.
