Spinal Cord Stimulation with Implantation of Surgical Leads is a Sufficient Salvage Therapy for Patients Suffering from Persistent Spinal Pain Syndrome-A Retrospective Single-center Experience.

Abstract

Objective: Persistent spinal pain syndrome (PSPS) poses a significant medical challenge, often leading to diminished quality of life for affected individuals. In response to this clinical dilemma, spinal cord stimulation (SCS) has emerged as a promising intervention aimed at improving the functional outcomes and overall well-being of patients suffering from this debilitating syndrome. In case a therapy with percutaneous lead fails (e.g., due to a dislocation), surgical lead can be used as a stable alternative. This results in a more invasive procedure and does not allow for intraoperative monitoring. The aim of this study is to investigate the efficacy and safety of the use of surgical leads, as there have been only a few case series published so far.

Methods: We included PSPS patients that gave consent to a SCS therapy and were treated with surgical leads. Outcome scores concerning the quality of life (Short Form Health Survey [SF-36]), pain related disability (Oswestry disability index [ODI]), sleeping quality (Pittsburgh Sleep Quality Index [PSQI]), and pain intensity (numeric rating scale [NRS]) were obtained prior to surgery and at outpatient visits after permanent implantation.

Results: In this study, 36 patients were implanted with a surgical lead SCS system. One patient developed a new neurologic deficit characterized by left-sided leg paresis attributable to postoperative hemorrhage, and another patient experienced a wound infection. These complications contributed to an overall morbidity rate of 5.6%. In 5 patients (20.8%), the electrodes were explanted within the first month. Follow-up data of 24 patients with a median follow-up time of 21 (interquartile range [IQR] 15-47) months were available. The mean pain intensity at rest and in motion was reduced. Further pain depending disability improved from a median ODI_preop = 38% [IQR 30%-57%] to ODI_follow-up = 21% [IQR 9%-35%] (P < 0.01). Additionally, the Sleeping Quality and the Quality of Life improved concerning the physical (median PCS _preop = 22.5 [IQR 20.4-30.4] vs. PCS_follow-up = 41.8 [IQR 35.2-47.0], P < 0.01) and mental (median MCS_preop = 45.4 [IQR 31.1-55.5] vs. MCS_follow-up = 58.1 [IQR 47.6-59.8], P = 0.018) component.

Conclusions: SCS with surgical leads is a safe secondary technique to treat PSPS, where treatment with percutaneous leads fail. The results show a promising long-term effect concerning pain intensity and functional outcome.