The Role of Additional Spine Surgery in the Management of Failed Back Surgery Syndrome, CRPS and Intractable Pain in the setting of Prior or Concurrent Spinal Cord Stimulation: Indications and Outcomes.

The Role of Additional Spine Surgery in the Management of Failed Back Surgery Syndrome, CRPS and Intractable Pain in the setting of Prior or Concurrent Spinal Cord Stimulation: Indications and Outcomes.

World Neurosurg. 2019 Jan 28;:

Authors: Maldonado-Naranjo AL, Golubovsky J, Frizon LA, Hogue O, Lobel DA, Machado AG, Steinmetz MP, Nagel SJ

Abstract
OBJECTIVE: Spinal cord stimulation (SCS) is both relatively safe and reversible. Although SCS is generally regarded as a last resort, some of these patients will have additional spinal surgery after the device is implanted or following its removal. The following is a descriptive study of subsequent spinal surgery following SCS.
MATERIALS AND METHODS: A retrospective review of patients who had percutaneous or paddle SCS leads placed at our institution between 2009 and 2016 was performed. Patients who only underwent trials or who did not undergo spine surgery following SCS implantation were excluded.
RESULTS: We identified 22 patients (5.7%) who underwent spine surgery during the course of SCS treatment, following SCS removal, or both, out of a total 383 patients who had paddle or/and percutaneous SCS. The most common additional spine interventions included 15 (42%) lumbosacral decompression and fusions. Out of 36 surgeries, the most frequent indications for subsequent intervention were stenosis/re-stenosis in 16 patients (73%) and spine deformity in 6 patients (27%). The median EQ-5D index preoperatively was 0.397 versus 0.678 in the postoperative group.
CONCLUSIONS: To our knowledge, this is the first study to describe spine surgery in the setting of SCS. Our results indicate that spine surgery subsequent or concurrent to SCS appears to occur in a minority of patients. Our study suggests a modest improvement in quality of life outcomes. Therefore, clinicians should take into account that patients may need further spine surgery despite the use of SCS, and thus may require re-evaluation by the spine team.

PMID: 30703586 [PubMed - as supplied by publisher]

from A via a.sfakia on Inoreader http://bit.ly/2MK8o4B