Epidural Spinal Cord Stimulation with a Multiple Electrode Paddle Lead Is Effective in Treating Intractable Low Back Pain

Barolat, Giancarlo; Oakley, John C.; Law, Jay D.; North, Richard B.; Ketcik, Beth; Sharan, Ashwini

doi:10.1046/j.1525-1403.2001.00059.x

Cited by 152 publications

(141 citation statements)

References 21 publications

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“…However, among patients with neuropathic pain, only 34% of cases required revision. 2,5,6,10,15,17 In addition, in this study, the median RFS was 28 and 47 months for axial back pain and neuropathic pain, respectively (p = 0.39; Fig. 8).…”

Section: Revision Timelinesupporting

confidence: 49%

Neuromodulation in intractable pain management: outcomes and predictors of revisions of spinal cord stimulators

Bir¹,

Konar²,

Maiti³

et al. 2016

FOC

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OBJECTIVE Spinal cord stimulators (SCSs) appear to be safe and efficacious for chronic intractable back pain. Although there are many reports on percutaneous SCSs, there are very few studies on outcomes of paddle lead SCSs. In addition, the predictors of requirement for SCS revision have not been well established. Here, the authors review the outcome of a case series and attempt to identify the predictors of SCS revisions. METHODS The clinical and radiological information of 141 patients with intractable chronic pain who underwent SCS implantation within the past 20 years was retrospectively reviewed. Paddle lead SCSs were used in this series. Statistical analysis was conducted using Kaplan-Meier curves and Cox proportional-hazards regression. RESULTS Among 141 cases, 90 (64%) did not require any revision after SCS implantations. Removal of the SCS was required in 14 patients. The average pain score was significantly reduced (preimplantation score of 8 vs postimplantation score of 1.38; p < 0.0001). Younger age, male sex, obesity, a preimplantation pain score ≥ 8, and the presence of neuromuscular pain were identified as predictors of the overall requirement for SCS revision. However, only a preimplantation pain score ≥ 8 was identified as a predictor of early failure of the SCS. CONCLUSIONS Implantation of a paddle lead SCS is a relatively less invasive, safe, and effective procedure for patients with intractable back pain. Revision of the procedure depends on many factors, including younger age, male sex, associated neuromuscular pain, and severity of the pain. Therefore, patients with these factors, for whom implantation of an SCS is planned, should be closely followed for the possible requirement for revision.

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Section: Revision Timelinesupporting

confidence: 49%

Neuromodulation in intractable pain management: outcomes and predictors of revisions of spinal cord stimulators

Bir¹,

Konar²,

Maiti³

et al. 2016

FOC

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“…A few recent studies have reported encouraging results using hybrid leads for treatment of axial LBP 14,26,27. Another study showed that SCS using a paddle lead with external radio-frequency stimulation benefited patients with predominantly axial LBP 28. Our current study shows that SCS with paddle leads connected to an implanted pulse generator provides sustained relief of axial LBP.…”

Section: Discussionsupporting

confidence: 64%

Spinal cord stimulation with implanted epidural paddle lead relieves chronic axial low back pain

Stidd

Rivero

Weinand

2014

JPR

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IntroductionSpinal cord stimulation (SCS) provides significant relief for lumbosacral radiculopathy refractory to both medical and surgical treatment, but historically only offers limited relief for axial low back pain (LBP). We aim to evaluate the response of chronic axial LBP treated with SCS using a surgically implanted epidural paddle lead.Materials and methodsThis is a retrospective review of a consecutive series of patients with exclusive LBP or predominant LBP associated with lower extremity (LE) pain evaluated and treated with SCS using an implanted paddle lead within the dorsal thoracic epidural space. Baseline LBP, and if present LE pain, were recorded using the visual analogue scale (VAS) at an initial evaluation. At a follow-up visit (a minimum of 12 months later), LBP and LE pain after a spinal cord stimulator implantation were again recorded using the VAS. Patients were also asked to estimate total LBP pain relief achieved.ResultsPatients with either exclusive (n=7) or predominant (n=2) axial LBP were treated with SCS by implantation of a paddle lead at an average spine level of T9. The baseline VAS score for LBP was 7.2; after a follow-up of 20 months, the score decreased to 2.3 (P=0.003). The LE pain VAS score decreased from 7.5 to 0.0 (P=0.103). Patients also reported a subjective 66.4% decrease of their LBP at follow-up. There were no surgical complications.ConclusionsAxial LBP is refractory to many treatments, including SCS. SCS using a surgically implanted paddle electrode provides significant pain relief for chronic axial LPB, and is a safe treatment modality.

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“…All of the above listed questionnaires along with GIC were recommended health-related quality of life (HRQOL) outcomes in chronic pain trials by the Initiative on Methods, Measurement and Pain Assessment in Clinical Trials (IMMPACT) [38]. Current traditional SCS therapies can cause sudden changes in paresthesias with activities as the position of the stimulating electrode and spinal cord varies [39]. Frequent interaction with the device, by changing the stimulation or turning the therapy off to avoid unwanted shocks, may be perceived as burdensome to patient's normal daily routine.…”

Section: Methodsmentioning

confidence: 99%

Long-term quality of life improvement for chronic intractable back and leg pain patients using spinal cord stimulation: 12-month results from the SENZA-RCT

Amirdelfan¹,

Doust

et al. 2018

Qual Life Res

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Purpose Chronic axial low-back pain is a debilitating disorder that impacts all aspects of an afflicted individual's life. Effective, durable treatments have historically been elusive. Interventional therapies, such as spinal cord stimulation (SCS), have shown limited efficacy at best. Recently, a novel treatment, 10 kHz SCS, has demonstrated superior pain relief compared with traditional SCS in a randomized controlled trial (RCT). In this manuscript, we report on the long-term improvements in quality of life (QoL) outcomes for subjects enrolled in this study. Methods A prospective, multicenter, randomized controlled trial (SENZA-RCT) was conducted. Patients with both chronic back and leg pain were enrolled and randomized (1:1) into 10 kHz SCS or traditional SCS treatment groups. A total of 171 subjects received a permanent SCS device implant. QoL and functionality measures were collected up to 12 months. The device remote control utilization, which is an indication of patient interaction with the device for adjustments, was collected at 24-month post-implantation.

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Epidural Spinal Cord Stimulation with a Multiple Electrode Paddle Lead Is Effective in Treating Intractable Low Back Pain

Cited by 152 publications

References 21 publications

Neuromodulation in intractable pain management: outcomes and predictors of revisions of spinal cord stimulators

Neuromodulation in intractable pain management: outcomes and predictors of revisions of spinal cord stimulators

Spinal cord stimulation with implanted epidural paddle lead relieves chronic axial low back pain

Long-term quality of life improvement for chronic intractable back and leg pain patients using spinal cord stimulation: 12-month results from the SENZA-RCT

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