痛みと緩和のジャーナル

抽象的な

High-frequency Spinal Cord Stimulation as a Palliative Treatment for Patients with Low Back and Lower Extremity Radiated Chronic Pain

Alcobia-Diaz B, Luque-Perez R, Urda Martínez-Aedo A, Noriega-Bastos M, Domínguez-Esteban I and Marco Martínez F

Introduction: Since "Gate Control" theory was published, Spinal Cord Stimulation (SCS) has been used in palliative management of Low-back Pain (LBP) and lower extremity Radiated Pain (RP) and functionality in patients with Lumbar Stenosis (LS), Degenerative Scoliosis (DS) or Failed Back Surgery Syndrome (FBSS). Our aim is to describe our experience with High Frequency Spinal Cord Stimulation (HF-SCS).
Methods: Descriptive, retrospective study (n=30) between 2014-2017 with HF-SCS due to intractable LBP and RP. Mean age was 69 (45-87), mean Comorbidity Charlson Index (CCI) was 6; 80% female with minimum follow up of 12 months. Items reviewed were time to implantation, VAS for LBP and RP and Owestry disability index (ODI), improvement in hungry, emotional status or sleeping; and personal satisfaction. Complications related to procedure were also recorded.
Results: HF-SCS was indicated in 25% patients because of LBP and LERP secondary to LS or not operable DS. Median time to surgery was 3 years (ICR 1-6). Pre and post-surgery mean (SD) values were VAS-LBP 8.63 (1.09) 4.43 (2.5); VAS-LERP 7.03 (2.84) 4.77 (2.49); and ODI 67.2 (11.9) 48.33 (16.93). All of these were statistically significant (p<0.01); 60% improved in sleeping and mood. No patient presented lower limbs paraesthesia, but 13% had electrodes mobilization. 73% were finally satisfied with treatment received.
Conclusion: HF-SCS use for refractory LB and RP could be an effective tool to improve patient pain and functionality with high satisfaction. Especially in those who are not candidates for corrective surgery because of their age or comorbidities.