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Surgical vs Percutaneous Spinal Cord Stimulation for Persistent Spinal Pain Syndrome Type 2: A Digital Pain Mapping
Thiziri Taïbi1, Maxime Billot2, Amine Ounajim3
1CHU de Poitiers, PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers, France; Université de Poitiers, CHU de Poitiers, INSERM, Centre d'investigation clinique CIC-IT 1402, Poitiers, France; CHU de Poitiers, service de neurochirurgie du rachis, chirurgie de la douleur et du handicap, France.
Background:
Persistent spinal pain syndrome type 2 (PSPS-T2) remains a significant challenge in chronic pain management, particularly when refractory to conventional treatments. Spinal cord stimulation (SCS) is an established therapeutic option, but the comparative effectiveness of paddle leads (PLs) and cylindrical leads (CLs) remains debated.
Objective:
This study aimed to objectively compare PLs and CLs in terms of pain coverage mapping and clinical outcomes using a digital pain-mapping tool and a multidimensional response index (MCRI).
Materials And Methods:
A retrospective, monocentric, real-world cohort study included 175 patients with refractory PSPS-T2 who were implanted with either PL (n = 35) or CL (n = 140) between 2018 and 2024. Pain coverage was assessed using the PRISMAP digital tool, whereas clinical outcomes (pain intensity, functional disability, quality of life, psychologic distress) were evaluated at baseline and at three, six, and 12 months after implantation. A propensity score-weighted analysis was conducted to mitigate selection bias.
Results:
In the weighted analysis, PL exhibited significantly superior back pain coverage to that of CL (88.0% vs 67.6%; p = 0.002) and greater improvements in MCRI, pain intensity (visual analog scale), and health-related quality of life (EuroQol 5 Dimension 5 Levels) at 12 months (p < 0.05). However, both lead types showed significant clinical benefits over time. CL was associated with a higher lead reimplantation rate (9.7%; p = 0.003).
Conclusions:
Although PL revealed superior spatial targeting and long-term clinical efficacy, both lead types provided meaningful pain relief in patients with PSPS-T2. However, given the relatively small sample size in the PL group and the substantial difference in follow-up duration between groups, these results should be interpreted cautiously owing to potential time-dependent confounding. The choice between PL and CL should be guided by patient-specific factors, including pain distribution, functional status, and surgical considerations. The integration of digital pain mapping offers valuable insights for optimizing SCS therapy and tailoring neuromodulation strategies to individual needs.
