Spinal cord stimulation in pregnant patients: Current perspectives of indications, complications, and results in pain control: A systematic review

Abstract

Spinal cord stimulation (SCS) has been described as a valuable neuromodulator procedure in the management of chronic medically untreated neuropathic pain. Although the use of this technique has been published in many papers, a question still remains regarding its applicability in pregnant patients. The goal of this paper is to discuss the risks, complications, and results as well as the prognosis of SCS in pregnant patients. We performed a systematic review from 1967 to 2018 using the databases MEDLINE, LILACS, SciELO, PubMed, and BIREME, utilizing language as selection criteria. Eighteen studies that met our criteria were found and tabulated. SCS is a reversible and adjustable surgical procedure, which results in patients that demonstrated a significant effect in the reduction of pain intensity in pregnant patients. The etiologies most frequent were complex regional pain and failed back pain syndromes, which together represented 94% of analyzed cases. The technical complications most frequent were lead migration (3%, n = 1). Regarding the risks, the authors did not show significative factors among the categorical variables that can suggest a teratogenicity, while the maternal risks have been associated to the consequences of technical complications due to, among other factors, improvement of abdominal pressure during pregnancy and delivery. Finally, although there are not significative cohorts of pregnant patients, the procedure is still an effective surgical approach of neuropathic pain associated to lower rates of complications and significative improvement in the quality of life of patients during pregnancy.

Burst Spinal Cord Stimulation in Pregnancy: First Clinical Experiences

“…The available evidence in humans is thus far limited to case series and case reports with a considerable overlap in reporting because the same cases are summarized in several reviews. 9,[16][17][18] Although no firm conclusions can be drawn from the available evidence, it is our opinion that the case reports do not support a negative effect of SCS on the developing fetus.…”

“…The most recent review (2019) by Camporeze et al 18 lists 18 reports with a total of 32 pregnancies in 25 patients (24 using tonic stimulation, one using HF10). Of those, 28 pregnancies resulted in a live-born neonate, three in miscarriages, and in one case, the outcome was not reported.…”