Peripheral nerve field stimulation in the treatment of postlaminectomy syndrome after multilevel spinal surgeries.

INTRODUCTION: Chronic low back pain in patients with postlaminectomy syndrome (PLS) is challenging to treat, especially for patients who have undergone multilevel surgical procedures. Despite conservative therapy and available interventional pain procedures including spinal cord stimulation (SCS) and intrathecal therapies, patients may continue with intractable low back pain. Peripheral nerve field stimulation (PNFS) may represent an effective alternative treatment option for these patients when conventional treatments do not provide adequate relief of intractable low back pain. METHODS: Eighteen patients underwent an uneventful PNFS trial with percutaneous placement of four temporary quadripolar leads (Medtronic, Inc., Minneapolis, MN, USA) placed subcutaneously over the lumbar or thoraco-lumbar area. RESULTS: After experiencing excellent pain relief over the next two days, temporary leads were removed. The patients were implanted with permanent leads and rechargeable or non-rechargeable generator two to four weeks after temporary lead removal. All patients reported sustained pain relief 12 months after implantation. DISCUSSION: PNFS with use of four vertically orientated leads provides an effective treatment option for patients with PLS after multilevel surgical procedures with intractable low back pain who have failed conservative treatment. PNFS may provide pain relief with advantages over conservative treatments and interventional treatments including SCS and intrathecal therapy. CONCLUSION: PNFS may be more effective in treating intractable low back pain than SCS in patients with PLS after multilevel spinal surgeries.

Spinal cord stimulation as alternative treatment for chronic post-herniorrhaphy pain.

OBJECTIVE: Our goal was to determine the efficacy of spinal cord stimulation for patients with intractable post-herniorrhaphy pain which conventional treatment failed to ameliorate. PROCEDURE: The patients underwent an uneventful spinal cord stimulator (SCS) trial with percutaneous placement of two eight-electrode epidural leads (Medtronic Inc, Minneapolis, MN, USA) to level T7-T8-T9. RESULTS: Upon experiencing excellent pain relief over the next two days during the trial, the patients were implanted with permanent leads and rechargeable or non-rechargeable generators two to four weeks later and reported sustained pain relief during following 12 months after implantation. CONCLUSION: We conclude that SCS offers an alternative treatment option for intractable post-herniorrhaphy pain. This type of treatment should be considered for use in a select group of patients when all conventional treatments failed.