Minimal-invasive Implantationstechnik eines Systems zur epiduralen Rückenmarkstimulation

Abstract

Spinal cord stimulation (SCS) targets structures of the dorsal column and dorsal horn of the spinal cord with electrical impulses, thereby, modulating pain perception. For chronic pain patients, e.g., in failed back surgery syndrome (FBSS), the aim is to achieve pain relief and enable patients to improve their quality of life. Failed back surgery syndrome, complex regional pain syndrome (CRPS) typeI andII, therapy-refractory ischemic pain, neuropathic pain syndromes (e.g., phantom limb pain). Identification of degenerative alterations as the cause of pain; untreated mental illness. Atwo-stage implantation technique is performed. Initially, after percutaneous implantation of epidural leads atrial period with stimulation by an external pulse generator is evaluated. Following verification of pain relief, asubcutaneous internal pulse generator is implanted. Early mobilization and adjustment of stimulation parameters. In all, 19 consecutive patients with FBSS were treated by high frequency SCS (HF-SCS) and included in aprospective prognostic study. In 18patients, an internal pulse generator (IPG) for HF-SCS was permanently implanted. Therapy success was assessed using the Oswestry Disability Index (ODI), visual analogue pain scale (VAS) and painDetect questionnaire. Neuropathic pain of the legs versus the back (median values: VAS leg 71 mm, VAS back 69 mm) was dominant in the patients at apreoperative mean ODI of 63%. With HF-SCS therapy, apronounced pain reduction was seen and persisted in the follow-up after 6months (VAS leg 18 mm, VAS back 24 mm). The ODI showed an improvement to amean of 24% after 6months.