Dorsal column stimulation for lumbar spinal stenosis

Surgical decompression has been considered the gold standard for the symptomatic spinal stenotic patient. Thirty thousand decompressive procedures are performed annually and this number is expected to increase as the American population ages. Options are limited for the stenotic patient classified as a "poor surgical risk". Furthermore review of the literature indicates mixed results even in optimal populations. Nonsurgical approaches including epidural steroids and percutaneous adhesiolysis have not been completely evaluated. Spinal cord stimulation has a long safe efficacious history in the treatment of neuropathic extremity pain but has never been evaluated in the treatment of spinal stenosis. This retrospective cohort of 55 patients receiving spinal cord stimulation was selected from a total of 72 patients presenting with spinal stenosis over a 4 year period. Twenty-one underwent subsequent permanent implantation with success rate of 67% at 1.5 years. Twelve elected to not receive implant despite "successful trial". 22 had "failed trial". Verbal pain scores, narcotic intake, and function were monitored. Spinal cord stimulation is a promising nondestructive alternative in the treatment of symptomatic spinal stenosis. Mild-moderate stenosis, predominate leg pain, and "positive" exercise treadmill appear to be positive predictors. Prospective trials with rigorous statistical designs are needed.