Spinal Cord Stimulation (SCS) in Conjunction With Peripheral Nerve Field Stimulation (PNfS) for the Treatment of Complex Pain in Failed Back Surgery Syndrome (FBSS)

Background: Failed back surgery syndrome (FBSS) is a well-defined pathologic condition observed over many years. Design: We have investigated the effect of spinal cord stimulation (SCS) with peripheral nerve field stimulation (PNfS) in eight patients with FBSS Outcome Measure: The following parameters were collected and analyzed: The pain intensity score on a 010 numbering rating scale (NRS), the psychologic profile with Beck Depression Inventory (BDI), the pain quality with McGill Pain Questionnaireshort form (MGPQ-sf), the back pain with Oswestry scale score (OS), and the health general quality pattern with QualityMetric's SF-36v2 (R) Health Survey. Patients: Eight patients with low back and radicular pain in FBSS are reported. The mean duration of pain was 6.7 months, and the mean NRS score was 9.5, BDI 28.8, MGPQ-sf 16.8, OS 44.5, and SF-36 score was 72.8. The average drug intake of opioids was 250mg/day. Intervention: In six patients, two octopolar leads were placed in epidural space at D7-D8 and D8-D9, in conjunction with two octopolar leads placed in lumbar-sacral subcutaneous space (Precision System, Boston Scientific, Valencia, CA, USA), and in two patients, a two tetrapolar leads was placed in epidural space at D8-D9 with two tetrapolar leads (Pisces Quad, Plus, Medtronic Inc., Minneapolis, MN, USA) placed in lumbar-sacral subcutaneous space (Restore Ultra, Medtronic Inc., Minneapolis, MN, USA). Results: After one year mean of follow-up, the mean NRS score was 4, BDI 8, MGPQ-sf 5, OS 21, and the SF-36 score was increased at 108.5. The mean drug intake of opioids was decreased at 20mg/day. Conclusion: The combination of SCS and PNfS, using the latest rechargeable systems, may be a valid therapeutic strategy in FBSS.