Objectives

Spinal cord stimulation (SCS) is being increasingly used in non-surgical intractable low back pain. This study was designed to evaluate the efficacy of High Dose (HD) SCS utilising sub-perception stimulation with higher frequency and pulse width in non-surgical predominant low-back pain population at 12 months.

Material and Methods

20 patients were recruited (280 screened between March 2017-July 2018) to undergo percutaneous fluoroscopic guided SCS (Medtronic 8 contact standard leads and RestoreR IPG), with T8 and T9 midline anatomical parallel placement. 16 patients completed 12 months follow up (500 Hz frequency, 500 microseconds pulse width, 25% pulse density). Differences in patients’ clinical outcome (NRS back, NRS leg, ODI, PGIC and PSQ) and medication usage (MQS) at one month, three months and twelve months from the baseline were assessed using non-parametric Wilcoxon paired test.

Results

The mean NRS scores for back pain (baseline 7.53) improved significantly at one, three and 12 months; 2.78 (p<0.001), 4.45 (p=0.002) and 3.85 (p=0.002) respectively. The mean NRS score for leg pain (baseline 6.09) improved significantly at one and three months; 1.86 (p<0.001) and 3.13 (p=0.010) respectively. Mean NRS for leg pain at 12 months was 3.85, (p=0.057). ODI and sleep demonstrated significant improvement as there was consistent improvement in medication particularly opioid usage (MQS) at 12 months.

Conclusions

This study demonstrates that anatomical placement of leads with sub-perception HD stimulation could provide effective pain relief in patients who are not candidates for spinal surgery.