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Updated: Jun 14, 2025
Treating Low Back Pain in Failed Back Surgery Patients with Multicolumn-lead Spinal Cord Stimulation
Published on: June 26, 2018
The impact of spinal cord stimulation on opioid utilization in failed back surgery syndrome and spinal surgery naïve
Adam Rupp1, Vinicius Tieppo Francio1, Jonathan M Hagedorn2
1Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
Background:
Spinal cord stimulation (SCS) has been utilized for failed back surgery syndrome (FBSS) with well-documented improvements in pain and function. However, limited studies have investigated the relationship between spinal surgery, SCS and opioid use outcomes.
Methods:
A narrative review utilizing the scale for the quality assessment of narrative review articles (SANRA) methodology looking at trials involving SCS and opiates.
Results:
Twenty-six studies met inclusion criteria. Surgery-naïve subjects had the greatest mean opioid dose reduction of 50.39% morphine milliequivalents, and the greatest number of patients who discontinued opioids at 53.72%. No statistical analysis was performed due to heterogeneous data.
Conclusion:
SCS has a positive impact on opioid reduction, regardless of prior spinal surgical history. However, due to a lack of homogenous data, a formal conclusion comparing outcomes between spinal surgical histories cannot be drawn. There is an inherent difficulty in evaluating this topic given its complexity and multifactorial origin. Studies would require collaboration between pain physicians, societies and industry. Even then, patient biases such as psychological and expectation would be difficult to account for. This topic remains an ongoing challenge for interventional pain physicians.
