Back Spinal leads – Spinal cord stimulation (SCS) is useful for leg pains where you can elicit Funny feeling “paresthesias” with implanted leads. Obtaining the same for back pain has been more difficult. In cases where they were unable to get the paresthesias in the back, or patient refused spinal leads, leads put in under the skin subcutaneously was used with some success.
SUBCUTANEOUS FIELD STIMULATION FOR REFRACTORY LOW BACK PAIN
B. Rutschmann1, C. Perruchoud1, A. Durrer1, B. Depierraz1, C. Koeppel2, E. Buchser1
IASP Poster PM 369 Montreal 2010
- Refractory cases – nothing else worked
- “Methods: Standard SCS lead and generator (Pisces Quad and Itrel 3, Medtronic Inc., Minneapolis USA) were used. The lead was inserted percutaneously using a Tuohy needle that was advanced laterally from the midline in the subcutaneous tissue of the lower back. “
- “Paraesthesia covering at least 80% of the painful area …elicited.”
- 3-week test phase before implantation
- 20 patients, even sex split, average age 54
- “The subjective improvement was 61%, 60%, 60%, 60%, 61% and 53% at 1, 3, 6, 12, 24 and 36 months respectively.” “The subjective improvement remains higher than 50% at 36 months.”
Comments – I was surprised they were able to elicit 80% paresthesia (funny feelings when prodded) rates and wonder if subjects were selected in part by their ability to show paresthesias when needled in appropriate areas… Effects compared to control tended to wane after 1 year but it was a good year… This technique appears to be in its infancy. An older study tried Spinal Cord Stimulation for predominantly back only pains:
Spine J. 2001 Sep-Oct;1(5):358-63.
Patient satisfaction with spinal cord stimulation for predominant complaints of chronic, intractable low back pain.
Ohnmeiss DD, Rashbaum RF. abstract here
- “60% of patients considered themselves improved from their preoperative condition
- the remaining 40% did not;
- 78.1% of patients would recommend SCS to someone with similar problems,
- 69.0% were satisfied,
- 75.0% would have the procedure performed again if they had known their outcome before implantation.
It looks like a toss-up – perhaps fields missed by spinal cord stim could be handled by peripheral field…