A Prospective, Randomized Study of Spinal Cord Stimulation versus Reoperation for Failed Back Surgery Syndrome: Initial Results

Abstract

Spinal cord stimulation (SCS) has been reported to be effective treatment for the failed back surgery syndrome in a number of retrospective case series. Its retrospectively reported results compare favorably with those of neurosurgical treatment alternatives, such as reoperation and ablative procedures. There has been no direct prospective comparison, however, between SCS and other techniques for pain management. We have undertaken a prospective, randomized comparison of SCS and reoperation in patients with persistent radicular pain, with and without low back pain, following lumboscral spine surgery. Patients selected for reoperation by standard criteria have been randomly assigned to initial treatment by one or the other technique. The primary outcome measure is the frequency of crossover to the alternative procedure, if the results of the first have been unsatisfactory after 6 months. Results for the first 27 patients reaching the 6-month crossover point show a statistically significant (p = 0.018) advantage for SCS over reoperation. This is one of many potentially important outcome measures, which are to be followed long-term as a larger overall study population accrues.

Spinal cord stimulation in chronic pain syndromes

“…44 Despite the extensive literature on SCS for FBSS, only one randomized study has yet been performed. 45 In this study SCS was compared to re-operation in patients with persistent radicular pain (with and without low back pain) following lumbosacral spine surgery. The primary outcome measure was the frequency of cross over to the alternative procedure, if results of the ®rst intervention were unsatisfactory after 6 months.…”

Subcutaneous stimulation as additional therapy to spinal cord stimulation in a post-laminectomy syndrome patient

“…[18] Taylor ve ark. yaptığı 72 hastayı içeren çalışmada, spinal kord stimülasyonu yapılan hastalarla (%37.5) tekrar operasyon geçiren hastalar (%11.5) karşılaştırıldı-ğında ağrıda %50'den fazla azalma tespit edilmiş.…”

Mechanisms of Spinal Cord Stimulation in Neuropathic Pain

“…They concluded that approximately 50 to 60% of FBSS experienced a clinically significant pain relief of more than 50% during SCS treatment at long-term (mean, 16 months; range, 1-45 months) follow-up visits. Furthermore, North et al presented some evidence in favor of SCS in relieving neuropathic pain compared to reoperation for FBSS, although results did not reach significance (North et al, 1994). SCS provides significant increased pain alleviation compared to conventional treatment when administrated in carefully selected FBSS patients suffering neuropathic pain.…”