Percutaneously implanted plates in failed back surgery syndrome (FBSS)

To evaluate the clinical efficacy of pain suppression in back area and lower extremities by recently developed plate electrodes for spinal cord stimulation through percutaneous access.

A retrospective analysis is performed: 20 consecutive patients with both lower extremity pain and low back pain, with low back counting for at least 30% of the overall pain were implanted with a small profile plate type lead, S-Series (SJM), via percutaneous approach. Patients were asked to rate their back and leg pain as well as their overall satisfaction and data on quality of life (QOL) on a (0-10 point) visual analog scale (VAS) before and after implantation. Medication use, functional pain (pain when bending forward, moving), and patient satisfaction scores also were collected.

A significant reduction of 55% and 45.7% in, respectively, VAS legs and VAS back pain was found. One year postoperatively the reduction was still present, respectively, 43% and 27% for the legs and the back. In 17 patients (85%) a clinically relevant reduction (defined as reduction of 2 points or 30% in VAS) in back pain was seen, with a mean decrease of 4.3 points (2.0-10.0) or 52% (22-100). Only three patients had no reduction in back pain, although they had reduction of their pain in the lower extremities. A significant and clinically relevant improvement of 66% and 70% was seen, respectively, for general satisfaction and QOL, respectively. One year postoperatively this improvement was still present, respectively, 69% and 75% for the satisfaction and QOL. Importantly functional pain also decreased by 51%. No infections occurred. Mean duration of post-op wound pain was 13.5 hours.

Percutaneous implantation of the S-Series plate electrodes using a 10 gauge epidural needle combines the advantages of a minimal invasive technique with the possibility to cover the back area supplementing leg coverage in 85% of the failed back surgery syndrome patients.