What is the efficacy of spinal cord stimulation (SCS) for the management of low back pain (LBP) and sciatica?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Taylor et al concluded that a moderate level of evidence supports the efficacy of SCS in chronic back and leg pain secondary to FBSS. [210] In another systematic review and meta-analysis, Taylor performed a systematic review and meta-analysis to evaluate SCS treatment of neuropathic back and leg pain secondary to FBSS and concluded that the overall evidence was strong based on the quality of available studies. [215] A Cochrane review for SCS found only limited evidence to support SCS for FBSS. [212] Frey et al found methodologically sound studies that supported the clinical use of SCS on a long-term basis for relief of chronic intractable pain from FBSS. [225]

Kumar et al compared SCS with conventional medical management (CMM) in patients with predominant leg pain from neuropathic radicular pain secondary to FBSS. At 12 months, the protocol analysis showed 48% of the SCS group and 9% of the CMM group were achieving at least 50% pain relief. By 24-month follow-up, 42 of 52 randomized patients who were still continuing SCS reported significantly improved leg pain relief, QOL, and functional capacity; however, 13 patients (31%) required a device-related surgical revision. [225] At 24 months, 46 of 52 patients randomized to SCS and 41 of 48 patients randomized to CMM were available for contact. The primary outcome was achieved by 34 of 72 patients (47%) who received SCS as their final treatment versus 1 of 15 (7%) for CMM. The authors concluded that compared with CMM, SCS provided improved leg and back pain relief, QOL, and functional capacity, and reported a significantly greater satisfaction with treatment. [226, 227]

North et al compared the results of treatment in a trial of chronic pain patients randomized to SCS versus repeated lumbosacral spine surgery. Of the 99 patients consecutively invited to participate in the study, 60 candidates consented to randomization and 50 proceeded with treatment; 45 patients (90%) remained available for follow-up. SCS was shown as more successful than reoperation in 9 of 19 patients versus 3 of 26 patients in the surgery group (P< 0.01). Long-term success at 2.9+1.1 years was presented in 47% of the SCS group, which was significantly higher than the 12% seen in the reoperation group (P< 0.01). [228]

Cost effectiveness of SCS was also examined in FBSS. Taylor et al found that initial health care costs for FBSS were offset by a reduction in post-SCS implant health care costs. Mean 5-year costs were $29,123 in the SCS intervention group compared with $38,029 in the control group. [219] Other investigators showed similar findings that illustrated the cost effectiveness of SCS even though initial health care acquisition costs for an implant are higher than most other treatments. [220, 221, 222, 223, 229]


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