Spinal Cord Stimulation in Treatment of Chronic Benign Pain: Challenges in Treat

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Neurosurgery. 2006 Mar;58(3

Spinal Cord Stimulation in Treatment of Chronic Benign Pain:

Challenges in Treatment Planning and Present Status, a 22-Year

Experience.

Kumar K, Hunter G, Demeria D.

Section of Neurosurgery, Department of Surgery, University of

Saskatchewan, Regina General Hospital, Regina, Canada (Kumar) Section

of Neurosurgery, Department of Surgery, University of Saskatchewan,

Regina General Hospital, Regina, Canada (Hunter) Section of

Neurosurgery, Department of Surgery, University of Saskatchewan,

Regina General Hospital, Regina, Canada (Demeria).

OBJECTIVE:: To present an in-depth analysis of clinical predictors of

outcome including age, sex, etiology of pain, type of electrodes

used, duration of pain, duration of treatment, development of

tolerance, employment status, activities of daily living,

psychological status, and quality of life. Suggestions for treatment

of low back pain with a predominant axial component are addressed. We

analyzed the complications and proposed remedial measures to improve

the effectiveness of this modality. METHODS:: Study group consists of

410 patients (252 men, 58 women) with a mean age of 54 years and a

mean follow-up period of 97.6 months. All patients were gated through

a multidisciplinary pain clinic. The study was conducted over 22

years.

RESULTS:: The early success rate was 80% (328 patients), whereas the

long-term success rate of internalized patients was 74.1% (243

patients) after the mean follow-up period of 97.6 months. Hardware-

related complications included displaced or fractured electrodes,

infection, and hardware malfunction. Etiologies demonstrating

efficacy included failed back syndrome, peripheral vascular disease,

angina pain, complex regional pain syndrome I and II, peripheral

neuropathy, lower limb pain caused by multiple sclerosis. Age, sex,

laterality of pain or number of surgeries before implant did not play

a role in predicting outcome. The percentage of pain relief was

inversely related to the time interval between pain onset and time of

implantation. Radicular pain with axial component responded better to

dual Pisces electrode or Specify-Lead implantation.

CONCLUSION:: Spinal cord stimulation can provide significant long-

term pain relief with improved quality of life and employment.

Results of this study will be effective in better defining prognostic

factors and reducing complications leading to higher success rates

with spinal cord stimulation.