Subcutaneous nerve stimulation : first french study in 80 patients Sylvie Raoul(1, 2),Amélie Levesque (2), Jean Michel N Guyen (3) , Emmanuelle Kuhn (2 ),Edwige de Chauvigny (2 ), Julien Nizard (2) Jean-Paul Nguyen (1) (1)Service de Neurochirurgie, Centre Hospitalier Universitaire Nantes, UIC 22 et EA3826, Nantes, France (2)Centre d Evaluation et de Traitement de la Douleur, Centre Fédératif Douleur-Soins de Support-Ethique Clinique, UIC 22 et EA3826, Centre Hospitalier Universitaire Nantes, France (3)Service de Biostatistique, Centre Hospitalier Universitaire Nantes, France
Objectif Spinal cord stimulation is now a treatment of pain in refractory failed back surgery syndrome. The effect on radiculalgias is quite good but often unsatifying to treat completely low back pain. Subcutaneous peripheral nerve stimulation is now one of the possibility to rescue chronic low back pain. The aim of this prospective study conducted in our center (Nantes, France) is to evaluate the benefit of the subcutaneous peripheral nerve stimulation on chronic low back pain. Surgical techniques: Epidural surgical lead plus 2 percutaneous lead Stimulators rechargeable and non rechargeable Inclusion Exclusion External trial during 7 days before device implanted Methods 18-75 year s old Anaesthesic contra-indication 80 patients were enrolled in this prospective study Neuropathic pain (DN4=6) 41 men, 39women Failure of medical treatment Psychiatric disorder With Neuropathic radicular and low back pain TENS + Mean Follow-up : 11months (range from 36 to 4 months) Figure 3 X-Ray control Evaluation : VAS pre-op and post-op Medication Quantification Score Figure 2 surgical technique Parameter settings Walking distance Results 78 % des patients ont des douleurs diminuées de 50% ou plus. L EVA passe de 8.4 en preop à 2.85 en post-op. les résultats sont stables dans le temps même s il y a necessité d adapter les réglages au fil du temps. Les paramètres de stimulation varient de 44 à 60Hz, de 90 à 325µs et de1.5 to 6.6mA. Les traitements ont été réduits de 50%. Le MQS passe de 18.8 en preop à 8.8 en post op. Les effets indésirables sont : infection 4 patients (6%), et 6 migrations d electrode (10%).
Figure 1 TENS
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Medtronic : medullaire: 1.7 v, 210 microseconds, 60hz 8 Subcutaneous : 3v,210 microseconds, 60hz 7 Indication for rechargeable stim
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ANS : medullaire: 2.1 mA, 208 microseconds, 54hz 4 Subcutaneous : 2.25mA,210 microseconds, 60hz3 Indication for rechargeable stim 2
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Boston : medullaire: 1.2mA, 200 microseconds, 60hz Subcutaneous : 1.8v,450 microseconds, 60hz Indication for rechargeable stim
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Conclusion This surgery is efficient to treat lomboradicular pain More studies are needed to see if subcutaneous stim plus spinal stimulation is more efficient to treat low back pain than large spinal cord electrode (Specify, Medtronic or Penta ANS) Results are good and improved patients, complications and side-effects are rare.
