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72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

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Combined high-frequency stimulation as a rescue therapy in patients with chronic low back and leg pain refractory to chronic SCS

Kombinierte Hochfrequenz-Stimulation als Rettungstherapie bei Patienten mit chronischen Lumboischialgien nach refraktären Schmerzen unter konventioneller SCS

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  • presenting/speaker Pablo Andrade - Universitätsklinikum Köln, Klinik für Stereotaxie und Funktionelle Neurochirurgie, Köln, Deutschland
  • Petra Heiden - Universitätsklinikum Köln, Klinik für Stereotaxie und Funktionelle Neurochirurgie, Köln, Deutschland
  • Veerle Visser-Vandewalle - Universitätsklinikum Köln, Klinik für Stereotaxie und funktionelle Neurochirurgie, Köln, Deutschland
  • Georgios Matis - Universitätsklinikum Köln, Klinik für Stereotaxie und Funktionelle Neurochirurgie, Köln, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocP089

doi: 10.3205/21dgnc377, urn:nbn:de:0183-21dgnc3776

Published: June 4, 2021

© 2021 Andrade et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: We aimed to investigate the efficacy of new stimulation paradigms in patients who initially benefited from conventional spinal cord stimulation (SCS) and lost the effect after months/years of stimulation.

Methods: Patients presenting with refractory low back and leg pain after chronic failure of SCS therapy were included in this study. In the context of a rescue-therapy, patients underwent an externalization of the implanted SCS leads in order to be tested with tonic and either contour or burst stimulation paradigms, and were eventually implanted with new generators. Pain intensity was analyzed using the numeric rating scale (NRS), and data were collected prior to externalization and at variable follow-ups after reimplantation.

Results: Thirty-seven patients (18 females and 19 males) with refractory pain after receiving chronic conventional SCS stimulation for at least one year underwent externalization of intraspinal leads. Mean preoperative NRS score was 8.1/10 points (SD±0.9) for the ON stimulation period. Patients received a combination of high-frequency stimulation at 1.2kHz, burst, tonic or dorsal horn high-frequency stimulation, or a combination of these algorithms. Postoperatively, a mean significant reduction of 48.0% was observed with the new paradigms (p<0.001). Mean postoperative NRS score was 3.8/10 points (SD±2.5). After this, 29 patients were reimplanted with new generators and in 8 cases the complete system was removed. No major complications were documented during the follow-up.

Conclusion: Rescue therapy SCS with combined high-frequency, burst and tonic wave forms can be associated with a successful pain reduction in patients with failed conventional chronic SCS. This approach can be considered as a safe and alternative method before considering explantation of the SCS system.