Outcomes of ECAP-controlled closed-loop spinal cord stimulation therapy in JAPAN: how to increase patient satisfaction with spinal cord stimulation

Abstract

Objective: Orthopedic surgeons commonly encounter patients with low back pain and leg pain. Despite conservative treatment, which may involve the use of weak opioids or NSAIDs, some patients do not experience improvement and may require increased dosages, contributing to concerns about opioid overuse overseas. Spinal cord stimulation (SCS) therapy, which can be trialed without surgical intervention, offers a potential treatment option. We evaluated Inceptiv (Medtronic), a generator that allows new stimulation settings using evoked compound action potentials (ECAPs)-controlled Closed-Loop technology. Methods: We evaluated six patients (four females, two males) who underwent implantation of the Inceptiv generator for SCS therapy. The average walking time (seconds) during a 2.1-meter walk and pain assessment using the Numerical Rating Scale (NRS) were conducted. Patient satisfaction was assessed using a 5-point scale: very satisfied (5), somewhat satisfied (4), neutral (3), somewhat dissatisfied (2), very dissatisfied. (1). Results: The average walking time improved from 11.8 seconds to 6.6 seconds, and the NRS score decreased from 7.6 to 4.2. Patient satisfaction was high, with four patients being very satisfied (5), one somewhat satisfied (4), and one neutral (3). Discussion: SCS therapy with Closed-Loop technology using the Inceptiv generator offers the potential to adjust electrical stimulation to minimize discomfort in daily activities and provide pain relief. It is considered a new treatment option for patients with common orthopedic conditions such as thoracolumbar compression fractures and lumbar spinal stenosis who suffer from chronic refractory pain in routine clinical practice.