Failure Back Surgery Post Laminectomy Pain Treatment- New High Frequency or Burst Mode Spinal Stimulation

Spinal stimulation is primarily for the sciatica -only 1/2 of back pains respond.. This leave a subgroup, with predominately back pain, with a need for options. High 10 Kz frequency stimulation and Burst stimulation are two options.

Neuromodulation. 2017 May 24. doi: 10.1111/ner.12611. [Epub ahead of print]
Burst or High-Frequency (10 kHz) Spinal Cord Stimulation in Failed Back Surgery
Syndrome Patients With Predominant Back Pain: One Year Comparative Data.
Muhammad S et al
https://www.ncbi.nlm.nih.gov/pubmed/28544182

  • “a considerable subgroup with predominant back pain using traditional SCS failed to achieve an adequate level of pain relief and return to activities of daily living”. They refer to

    Kinfe TM, Pintea B, Link C et al. High Frequency (10 kHz) or burst spinal cord stimulation in failed back surgery syndrome patients with predominant back pain:preliminary data from a prospective observational study. Neuromodulation 2016;19:268–275.
    which merely states
    “in contrast to patients with neuropathic leg pain dominant FBSS, the back pain FBSS subgroup has emerged as a difficultto-treat population with a less favorable outcome.” –
  • They discuss:
    “SENZA-RCT assessed the capability of 10 kHz SCS vs. tonic, conventional SCS in refractory chronic back and leg pain of different origin (11). Out of 198 enrolled patients 79% suffered from FBSS and experienced reduction of 78.7% for the 10-kHz group vs. 51.3% for the tonic group after 12 months with complication rates comparable with earlier published studies. The extension of the SENZA-trial (24months secondary result) pronounced the favorable 10 kHz SCS out-come for back pain (10 kHz: 76.5% vs. 49.3% tonic SCS) and for leg pain (10 kHz: 72.9% vs. 49.3% tonic SCS) supporting the superiority of 10 kHz SCS over tonic SCS for intractable back and leg pain”
    11 Kapural L, Yu C, Doust MW et al. Novel 10-kHz high-frequency therapy (HF10 Therapy) is superior to traditional low-frequency spinal cord stimulation for the treatment of chronic back and leg pain: the SENZA-RCT randomized controlled trial. Anesthesiology 2015;123:851–860.

 

  • Results of stim therapy of 16 cases in two groups

  • Lack of efficacy in 3 cases – out of 16
  • all had beck depression score 20-30 (moderate) – all but 2 effective cases were below 20 afterwards.

Comment -Chance if a stimulator helping post laminectomy back pain is 50-50 while with new stim methods can be 3/4 responding. In this study of if back pain, the burst stimulator looks the best.

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