痛みと緩和のジャーナル

抽象的な

Spinal Cord Stimulation Failures in Refractory Chronic Pain

Lavano Angelo*, Guzzi Giusy, Della Torre Attilio, Tiriolo Raffaele, Lavano Francesco and Volpentesta Giorgio

Background: Spinal cord stimulation (SCS) is a well-established modality for the treatment of refractory chronic pain and may utilize percutaneous or paddle leads.

Methods: The study is conducted at the Unit of Functional Neurosurgery of University “Magna Græcia” of Catanzaro. We perform a retrospective review of our prospective database of 523 SCS patients undergoing surgery for routine indications between January 1993 and December 2013 to evaluate failures rates during trial period and during chronic stimulation.

Results: SCS trial was less effective for patients with differentiation neuropathic pain and post herpetic pain. Patients with allodynic dominant pain can feel unpleasant or painful parenthesis during trial stimulation. SCS trial has presented a very low hardware-associated complication rate (lead migration 1.3%) and absence of biological complications. During chronic SCS 29% of cases had equipment failures. In particular mechanical failures occurred in 18% of cases with 8.5% of lead displacements or migrations and 9.5% of lead breakages; biological failures occurred in 11% of cases with 6% of skin erosions and 5% of infections.

Conclusion: SCS is a minimally invasive procedure effective in managing medically intractable pain of various origins. Despite advances in the design and production of SCS systems, these devices remain prone to failure from various causes. A careful analysis of mechanical complications coupled to a clinical strategy to minimize the tensile loads on the components of the system should lead to an improvement of the performance of the SCS implanted system and the effectiveness of the stimulation and the long-term reduction in the rate of complications that currently it remains quite significant.