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Dorsal column stimulation for lumbar spinal stenosis.
Gilbert S Chandler1, Bruce Nixon, L Todd Stewart
1Medical Director, Department of Pain Management, Specialty Clinics of Georgia, 1240 Jesse Jewell Parkway, Suite #300, Gainesville, GA 30501, USA. sewell87@aol.com
Pain Physician
|August 1, 2006
Summary
Spinal cord stimulation (SCS) shows promise as a non-destructive treatment for spinal stenosis, offering a 67% success rate in patients who underwent permanent implantation. This approach may be particularly effective for mild-moderate stenosis with leg pain.
Area of Science:
- Neurosurgery
- Pain Management
- Medical Devices
Background:
- Surgical decompression is the standard for symptomatic spinal stenosis, but options are limited for high-risk patients.
- Existing non-surgical treatments like epidural steroids and percutaneous adhesiolysis are not fully evaluated.
- Spinal cord stimulation (SCS) is effective for neuropathic extremity pain but unproven for spinal stenosis.
Purpose of the Study:
- To evaluate the efficacy and safety of SCS as a treatment for symptomatic spinal stenosis.
- To identify predictors of success for SCS in spinal stenosis patients.
Main Methods:
- Retrospective cohort study of 72 patients with spinal stenosis over 4 years.
- 55 patients received SCS, with 21 undergoing permanent implantation after a trial.
- Pain scores, narcotic intake, and function were monitored.
Main Results:
- A 67% success rate was observed at 1.5 years for patients with permanent SCS implants.
- Twelve patients declined implantation despite a successful trial; 22 experienced a failed trial.
- Mild-to-moderate stenosis, predominant leg pain, and a positive exercise treadmill test predicted success.
Conclusions:
- Spinal cord stimulation is a promising, non-destructive alternative for symptomatic spinal stenosis.
- Further prospective trials are needed to confirm these findings and optimize patient selection.