Peripheral Ner ve Field Stimulation (PNFS) for Treatment of Failed Back Syndr ome (FBS)
Alexander E. Yakovlev, M.D., Yakub Ellias, M.D., and Josh Joseph, M.D.
Department of Interventional Pain Management, Marshfield Clinic, Marshfield, WI 54449
and Medical College of Wisconsin, Milwaukee, WI 53201
INTRODUCTION
Patients with failed back syndrome continue to experience low back pain despite conventional treatments and minimally invasive procedures including spinal cord stimulation. Control of axial low back pain is difficult to achieve during the trial placement of spinal cord stimulation or to maintain after permanent placement.1 Peripheral nerve field stimulation has been applied to patients with injuries to a specific nerve, 2 including occipital, 3-6 ilioinguinal, 7 supraorbital, 8,9 and trigeminal neuralgia. 10 Peripheral nerve field stimulation utilizes percutaneous placement of leads in the area of pain and direct stimulation focally to affected nerve interventions, 11 and was applied in this study of patients with failed outcomes to back pain.
MATERIALS AND METHODS
Patients with failed back syndrome (n=52; including 18 patients with existing spinal cord stimulation and 11 patients with implanted intrathecal pumps) underwent peripheral nerve field stimulation placement. Patients were assessed at baseline and outcomes compared at 1, 3, 6 and 12 months postoperatively relative to pain relief (>50% improvement on the visual analog scale), functional status and pain medication use.
RESULTS
A total of 84.6% of patients reported 50% or more pain relief at 1 month, 88.4% at 3 months, 90.3% at 6 and 12 months in response to neuromodulation. Improvement of functional status was reported by 53.8%, 61.5%, 67.3%, and 78.8% of patients at 1, 3, 6 and 12 months, respectively. Overall 40.3%, 63.4%, 76.9%, and 82.6% of patients indicated reduction in pain medication intake at 1, 3, 6 and12 months, respectively. Five patients with intrathecal pumps exhibiting good pain control with peripheral nerve field stimulation underwent removal of intrathecal devices.
CONCLUSION
Peripheral nerve field stimulation produced clinically effective outcomes in this trial. The approach provided safe, minimally invasive, efficacious treatment for patients refractory to traditional treatment and further enhanced treatment outcomes afforded by spinal cord stimulation or intrathecal pump placement.
FIGURES
REFERENCES
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