Patient satisfaction with spinal cord stimulation for predominant complaints of chronic, intractable low back pain

• Published in: The spine journal 2001-09, Vol.1 (5), p.358-363
• Main Authors: Ohnmeiss, Donna D, Rashbaum, Ralph F
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Chronic Disease; Chronic pain; Electric Stimulation Therapy; Failed back surgery syndrome; Female; Humans; Low back pain; Low Back Pain - surgery; Low Back Pain - therapy; Male; Middle Aged; Pain, Intractable - surgery; Pain, Intractable - therapy; Patient Satisfaction; Postoperative Complications; Reoperation; Retrospective Studies; Spinal Cord - physiology; Spinal Cord - surgery; Spinal cord stimulation
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/S1529-9430(01)00083-3

Background context: Results of subsequent surgical intervention in patients with intractable pain after lumbar spine surgery are typically worse than for initial surgery, particularly in those with predominant complaints of back pain rather than lower extremity pain. Spinal cord stimulation (SCS) has been found to yield good results in patients with primary complaints of intractable lower extremity pain. Technological advances have broadened the indications for this treatment. Purpose: The purpose of this study was to evaluate patient satisfaction after SCS in the treatment of patients with predominant complaints of chronic, intractable, low back pain. Study design/setting: Data were collected from retrospective chart review and patient follow-up questionnaire. Patients were treated at a spine specialty center. Patient sample: The study group consisted of the consecutive series of our first 41 patients who underwent SCS for predominant complaints of low back pain. The mean symptom duration was 82.9 months, and the mean age was 47.9 years (range, 28–83 years). All but three patients had previously undergone lumbar spine surgery (mean, 2.3 prior surgeries). Outcome measures: At the time of follow-up (5.5–19 months after SCS implantation), patients completed questionnaires assessing their satisfaction with their outcome, if they would have the procedure again knowing what their outcome would be and if they would recommend SCS to someone with similar problems. In determining outcome, a negative response was assigned for patients who had the device removed. A worst-case analysis was also conducted in which a negative response was assigned for patients lost to follow-up or who failed to respond to a particular question. Data were also collected on complications and re-operations. Methods: All trial stimulation procedures were performed under local anesthetic with the patient providing feedback concerning pain relief achieved with various lead placements and settings. If one lead did not provide acceptable relief in all the areas needed, placement of a second lead was pursued. If the patient failed to maintain acceptable pain relief (⩾50% pain relief) during a multiday trial period, the leads were removed. If adequate relief was maintained during the trial period, the receiver was implanted. Results: Responses to the follow-up questionnaire indicated that 60% of patients considered themselves improved from their preoperative condition and the remaining 40% did no