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KMID : 0614520040140010094
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Journal of the Korean Pain Research Society
2004 Volume.14 No. 1 p.94 ~ p.98
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Laminectomy VS Percutaneous Electrode Placement Undergoing SCS
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Kim Moo-Seong
Jin Sung-Jin
Pyo Se-Young
Jeong Young-Gyun
Lee Sun-Il
Jung Yong-Tae
Kim Soo-Chun
Sim Jae-Hong
Kim J Burchiel
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Abstract
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Background: Although percutaneous techniques are associated with several attractive advantages, there is currently no objective evidence evaluating which electrode systems have better long-term outcomes. The purpose of this study was to evaluate the long-term efficacy of spinal cord stimulation (SCS) using open laminectomy versus percutaneous-styled electrodes. We reviewed our experience with SCS. A comparison of outcome using modern percutaneous and laminectomy electrodes is presented.
Methods: Forty-five patient were identified who underwent SCS. All patients were referred for SCS from a multidisciplinary pain clinic having completed at least 6 months of conservative treatment with PT, pain medications and in some case, epidural injections. Routine psychological evaluation was performed in all patients prior to treatment. The majority of patients (69%) were diagnosed with failed back surgery syndrome, followed in number by neuropathic pain syndromes (22%), complex regional pain syndrome (2%), and all other etiologies (7%). All patients were screened with a temporary electrode system in order to establish satisfactory relief of pain before internalization of permanent system. Trial stimulation was performed through the use of a percutaneous catheter-type electrode in 21 patients, and through use of a laminectomy-type electrode in the other 24 patients. After screening 45 patients, 39 (87%) proceeded to undergo permanent implantation. Pre- and Postoperative pain levels were based on the administration of visual analogue scale (VAS). A modified outcome scale was used to compare the long-term efficacy of SCS.
Results: Visual analogue scale (VAS) decreased an average of 4.8 for patients undergoing SCS placement via laminectomy. Patients who underwent percutaneous placement of electrodes had an a verage decrease in VAS of 3.4. Percutaneous electrodes were associated with good or excellent outcome in 52% of patients, fair in another 24% and poor in 24%. Electrodes placed through laminectomy exhibited good or excellent outcome in 70%, fair in 17%, poor in 13%. There was no mortality directly associated with surgery. There were 7 revisions required after trial of SCS.
Discussions: 1) Spinal cord stimulation is a safe and useful, minimally invasive procedure for the treatment of chronic pain. 2) Laminectomy styled electrodes appear to be associated with improved long-term effectiveness over those placed percutaneously.
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KEYWORD
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Spinal cord stimulation, Laminectomy, Percutaneous electrode
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