Back pain: a real target for spinal cord stimulation?

Area of Science:

• Neurology
• Pain Management
• Biomedical Engineering

Background:

• Failed back surgery syndrome (FBSS) is a primary cause of chronic back pain, posing a significant public health challenge.
• Current spinal cord stimulation (SCS) systems face technological limitations hindering their effectiveness for back pain.
• New multi-column leads offer advanced stimulation capabilities for the spinal cord.

Purpose of the Study:

• To evaluate the efficacy of multi-column tripolar leads in achieving back pain coverage.
• To assess the capacity of these leads in providing paresthesia in the back territory for FBSS patients.

Main Methods:

• Eleven FBSS patients were implanted with a 16-contact SCS lead (Specify 5-6-5).
• Extensive stimulation testing explored 43 configurations for bilateral back and leg paresthesia.
• Systematic assessment focused on achieving dorsal paresthesia coverage.

Main Results:

• Multi-column tripolar leads successfully generated paresthesia in both back and leg regions for 81.8% of patients.
• Success rates for multi-column patterns were superior to longitudinal configurations for back paresthesia.
• Significant pain reduction was observed at 6 months post-implantation (global, leg, and back pain).

Conclusions:

• Multi-column leads demonstrate reliability in providing back pain coverage and improving pain relief outcomes.
• These findings may prompt a reevaluation of SCS indications for chronic back pain.
• Neurostimulation for intractable back pain syndromes appears increasingly feasible.