Introduction

Some patients with degenerative lumbar stenosis have severe concomitant pathology and open surgery is too risky for them. In such cases spinal cord stimulation can been performed as a palliative alternative method [1, 2, 3].

Methods/Materials

A prospective study was conducted among 20 patients with degenerative lumbar stenosis. All patients had radicular symptoms or neurogenic claudication. Most patients (n = 18) were rejected from open decompression because of severe concomitant somatic pathology. Two patients refused from open intervention, they were offered stimulation. All patients (n=20) were implanted of the test epidural electrode for spinal cord stimulation. The exclusion criterion was the presence of mechanical axial pain in the lumbar region. Outcomes were assessed by using a visual analogue scale (VAS) and increasing of the distance of non-stop walking in 8 days after surgery. Among patients with chronic spinal cord stimulation, outcomes were assessed in 6 months after implantation. A satisfactory result was considered as a decreasing of pain more than 50% (according to VAS)

Results

А satisfactory result of test stimulation was noted in 18 patients, all of them were implanted of system of the chronic spinal cord stimulation. The average value of lumbar pain changed from 4.2 to 3.1 points, and the average value of leg-pain changed from 7.2 to 2.2 points. The average value of the non-stop walking distance changed from 58 to 245 meters. At the same time, the motor component of neurogenic claudication decreased in only single patient. In some patients, after regression of radicular pain, heart complaints became the main factor limiting walking. Before stimulation only three patients had no walking restriction. After stimulation seven patients had no walking restriction. We have some complications, one foot drop after 6 months of implantation. After one year of implantation one patient had period of increasing acute pain for one month with no analgetic effect from stimulation. There were three reoperations after several months of implantation: explantation because of infection, electrode replacement because of breakage, second electrode implantation because of pain occurrence in opposite leg.

Discussion

This technology in patients with symptomatic lumbar stenosis is a purely palliative option, because the mechanical cause of compression is not removed. Nevertheless, all patients in this observation are satisfied with the stimulation during the observation period.

Conclusions

Spinal cord stimulation is an effective palliative option in patients with degenerative lumbar stenosis.

References

1. Kamihara M, Nakano S, Fukunaga T, Ikeda K, Tsunetoh T, Tanada D, Murakawa K. Spinal cord stimulation for treatment of leg pain associated with lumbar spinal stenosis. Neuromodulation. 2014 Jun;17(4):340-4. DOI: 10.1111/ner.12092.

2. Costantini, A., Buchser, E., & Van Buyten, J. P. (2010). Spinal cord stimulation for the treatment of chronic pain in patients with lumbar spinal stenosis. Neuromodulation: Technology at the Neural Interface, 13(4), 275–280. DOI:10.1111/j.1525-1403.2010.00289.x

3. Chandler G., Nixon B., Stewart L., Love J. Dorsal column stimulation for lumbar spinal stenosis. Pain Physician. 2003; 6(1):113-8. PMID: 16878166