Spinal Cord Stimulation for Failed Back Surgery Syndrome -- Patient Selection Considerations

Area of Science:

• Neurology
• Pain Management
• Surgical Outcomes

Background:

• Failed back surgery syndrome (FBSS) presents persistent pain post-back surgery, historically challenging to treat.
• Spinal cord stimulation (SCS) offers a promising therapeutic avenue for FBSS patients.
• Critical appraisal is needed to define optimal patient selection for SCS in FBSS.

Purpose of the Study:

• To systematically review the efficacy of spinal cord stimulation (SCS) for failed back surgery syndrome (FBSS).
• To identify patient characteristics influencing SCS outcomes, including work status, psychological factors, and demographics.
• To highlight areas needing further research in SCS for FBSS.

Main Methods:

• Systematic review of randomized controlled trials and cohort studies with matched controls.
• Synthesis of data on overall SCS efficacy for FBSS.
• Analysis of outcome variations based on patient descriptors like work status, psychological status, smoking, sex, and race.

Main Results:

• Eleven publications were reviewed, with seven showing potential funding or affiliation bias.
• SCS demonstrated statistically significant improvement in radiating leg pain in 3 of 4 studies.
• Improvement in functional status and quality of life was noted in RCTs, but data on psychological status, smoking, sex, or race was limited.

Conclusions:

• Accumulating evidence supports SCS efficacy in FBSS, especially for predominant leg pain.
• Potential bias from funding sources and limited long-term (beyond two years) efficacy data are significant weaknesses.
• Further research should focus on refining patient selection and understanding the substantial placebo effect in SCS for FBSS.