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Peripheral Nerve Stimulation Implantation Combining Ultrasound With Microendoscopy for Management of Chronic
Bénédicte Bouche1, Maxime Billot2, Arthur Voratanouvong1
1CHU de Poitiers, Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery Lab, Poitiers, France; CHU de Poitiers, Spinal Neurosurgery, Neuromodulation & Surgery for Handicap, Poitiers, France.
Background:
Peripheral nerve stimulation (PNS) has emerged as a minimally invasive percutaneous procedure addressing neuropathic pain. However, the percutaneous cylindrical lead ultrasound-guided implantation procedure requires expertise that limits widespread PNS utilization. To overcome these challenges, a microinvasive endoscopy device has very recently been developed, enhancing the precision of PNS implantation by providing accurate visualization of the targeted nerve. We aimed to determine the feasibility, safety, clinical effectiveness, and energy consumption of PNS therapy by means of ultrasound guidance combined with microendoscopy.
Materials And Methods:
This is a retrospective, single-center, single-arm study. Patient recruitment was performed in February and March 2023. Patients with >12 months of upper or lower limb pain presenting with pain >5 of 10 that was refractory to conventional treatments were eligible. Safety was assessed by collecting adverse events and complications related to the PNS implantation with microendoscopy. The Multidimensional Clinical Response Index (MCRI), pain intensity (visual analog scale [VAS]), pain surface (PRISMap Software, PRISMATICS lab, CHU de Poitiers, Poitiers, France), quality of life (EuroQoL 5 dimensions 5 levels [EQ5D-5L]), functional disability (Oswestry Disability Index [ODI]), anxiety and depression (Hospital Anxiety and Depression Scale), and energy consumption were assessed at baseline and at one and three months.
Results:
Six patients received PNS, which was implanted through ultrasound guidance combined with microendoscopy. No adverse event was reported during the three-month follow-up. Clinical outcomes (MCRI, VAS, ODI, EQ5D-5L) significantly increased at one- and three-month follow-up. Energy consumption was, on average, 2.6 ± 1.1 μC.s-1 at one-month and 3.3 ± 2.0 μC.s-1 at three-month follow-up.
Conclusions:
Implanted PNS by means of ultrasound combined with microendoscopy was safe and provided clinical benefits with very low energy consumption (15-440 times less than spinal cord stimulation) in patients with upper or lower limb neuropathic pain. Microendoscopy would offer extended PNS indications, overcoming limitations associated with ultrasound alone. Future research is nonetheless needed to provide stronger evidence through randomized controlled trial design.
