Incidence and predictive factors of spinal cord stimulation treatment after lumbar spine surgery

Abstract

Merja Vakkala,1 Voitto Järvimäki,1 Hannu Kautiainen,2,3 Maija Haanpää,4,5 Seppo Alahuhta1 1Department of Anaesthesiology, Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, 2Primary Health Care Unit, Kuopio University Hospital, Kuopio, 3Folkhälsan Research Center, Helsinki, 4Department of Neurosurgery, Helsinki University Hospital, 5Mutual Insurance Company Etera, Helsinki, Finland Introduction: Spinal cord stimulation (SCS) is recommended for the treatment of postsurgical chronic back and leg pain refractory to other treatments. We wanted to estimate the incidence and predictive factors of SCS treatment in our lumbar surgery cohort.Patients and methods: Three questionnaires (a self-made questionnaire, the Oswestry Low Back Pain Disability Questionnaire, and the Beck Depression Inventory) were sent to patients aged 18–65 years with no contraindications for the use of SCS, and who had undergone non-traumatic lumbar spine surgery in the Oulu University Hospital between June 2005 and May 2008. Patients who had a daily pain intensity of ≥5/10 with predominant radicular component were interviewed by telephone.Results: After exclusions, 814 patients remained in this cohort. Of those, 21 patients had received SCS by the end of June 2015. Fifteen (71%) of these received benefit and continued with the treatment. Complications were rare. The number of patients who replied to the postal survey were 537 (66%). Eleven of them had undergone SCS treatment after their reply. Features predicting SCS implantation were daily or continuous pain, higher intensities of pain with predominant radicular pain, more severe pain-related functional disability, a higher prevalence of depressive symptoms, and reduced benefit from pain medication. The mean waiting time was 65 months (26–93 months). One hundred patients were interviewed by telephone. Fourteen seemed to be potential SCS candidates. From the eleven patients who underwent SCS after responding to the survey, two were classified as potential candidates in the phone interview, while nine were other patients. Twelve patients are still waiting for treatment to commence. Conclusion: In our region, the SCS treatment is used only for very serious pain conditions. Waiting time is too long and it may be the reason why this treatment option is not offered to all candidates. Keywords: disc surgery, spinal fusion, decompression surgery, chronic back and leg pain, Beck Depression Inventory, Oswestry Disability Index

Keywords

• lumbar spine surgery
• chronic back and leg pain
• spinal cord stimulation