Conventional versus High‐Frequency Neuromodulation in the Treatment of Low Back Pain Following Spine Surgery

Abstract

A 54-year-old man presents with history of low back pain radiating to the right lateral leg as well as pain in the dorsum of the foot. He describes the symptoms as stabbing and burning. The symptoms began 5 years ago at which point he was treated with neuropathic medications, two rounds of epidural steroid injections, both transforaminal and interlaminar approaches, as well as physical therapy. Four years ago, the patient underwent an L4-S1 transforaminal lumbar interbody fusion for stenosis and neurogenic claudication. He did well for 3.5 years and reported 80% to 90% relief during that time. He now presents with recurrence of primarily low back pain (90%) with minimal right leg pain. Updated imaging reveals stable hardware and no evidence of adjacent segment disease. The spinal canal is patent and there is mild foraminal stenosis at L4-5 and L5-1. Both a caudal epidural steroid injection and sacroiliac joint injections were unsuccessful. Currently the patient is taking 50 mg morphine equivalent daily and gabapentin and baclofen. Electrodiagnostics demonstrate chronic mild right L5 radiculopathy. The patient has read about spinal cord stimulation online and is interested in learning more about this therapy modality. You first address his psychological profile through a formal evaluation and no red flags are noted that would preclude proceeding. Drs. Joseph Sclafani and Michael Leong will argue that conventional neurostimulation has a proven track record of success and this modality will offer this patient the best coverage of his pain. Drs. Mehul Desai, Neel Mehta, and Dawood Sayed will argue that new waveform high-frequency (HF) stimulation is more likely to provide this patient with pain relief and functional improvement.

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“…Nearly 80% of people will suffer from low back pain in their own life span [3]. Drug therapy (Non-steroidal anti-inflammatory drugs or pregabalin), vertebrectomy and decompression can alleviate the low back pain [4,5]. However, recurrent pain and disc degeneration of adjacent segments were the weakness of these two therapies [6].…”

The Invasive Management of Pain: Diagnosis and New Treatment Options

“…Instead, electrodes are placed anatomically based on pain site locations. Comparative studies of low-versus high-frequency spinal cord stimulation have been favorable in that high-frequency works as well if not better than low-frequency stimulation [67][68][69]. An intriguing and promising idea being studied now is the potentially synergistic combination of high-frequency spinal cord stimulation plus conventional low-frequency stimulation.…”

Myricetin alleviates H2O2-induced senescence and apoptosis in rat nucleus pulposus-derived mesenchymal stem cells

“…Approximately 90% of individuals are diagnosed with IDD when they are over 50 years old [4]. Currently, vertebrectomy, decompression, and drug therapy slightly relieve the pain [5]. In practice, however, disc degeneration of adjacent segments and recurrent pain are adverse reactions accompanying these therapies [6].…”