Restorative Neurostimulation: A Clinical Guide for Therapy Adoption

Abstract

Krishnan Chakravarthy,1,2 David Lee,3 Jennifer Tram,1 Samir Sheth,4 Robert Heros,5 Smith Manion,6 Vikas Patel,7 Kyle Kiesel,8 Yousef Ghandour,9 Christopher Gilligan10 1Department of Anesthesiology and Pain Medicine, University of California San Diego Health Sciences, San Diego, CA, USA; 2VA San Diego Healthcare System, San Diego, CA, USA; 3Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, USA; 4Sutter Health System, Roseville, CA, USA; 5Spinal Diagnostics PC, Tualatin, OR, USA; 6Advent Health Pain Specialists, Merriam, KS, USA; 7Department of Orthopedic Surgery, University of Colorado, Denver, CO, USA; 8Department of Physical Therapy, University of Evansville, Evansville, IN, USA; 9Physical Rehabilitation Network (PRN), University of St. Augustine, San Diego, CA, USA; 10Division of Pain Medicine, Brigham & Women’s Hospital/Harvard Medical School, Boston, MA, USACorrespondence: Krishnan Chakravarthy, Department of Anesthesiology and Pain Medicine, University of California San Diego Health Sciences, San Diego, CA, USA, Email [email protected]: In this review, we present a comprehensive clinical approach to restorative neurostimulation, a novel form of stimulation for refractory chronic mechanical low back pain, targeting impaired neuromuscular control and degeneration of the multifidus muscle. We focus on patient identification, technique guidance, and review of the scientific background and clinical evidence. As our understanding of back pain grows, there is clear evidence that impaired neuromuscular control and consequent degeneration of the multifidus muscle contribute to mechanical low back pain development and maintenance. We provide clinical guidance regarding an implantable restorative neurostimulation system that targets impaired neuromuscular control. Supported by results from a randomized, active-sham-controlled clinical trial with long-term follow-up, we provide clinicians with a comprehensive overview and practical clinical guidance for the adoption of this therapy modality.Keywords: restorative neurostimulation, multifidus, arthrogenic inhibition, neuromodulation, chronic mechanical low back pain, neuromuscular control

Keywords

• restorative neurostimulation
• multifidus
• arthrogenic inhibition
• neuromodulation
• chronic mechanical low back pain
• neuromuscular control