Preoperative Radiological Finding at the Lumbar Spinal Level Is a Novel Predictive Factor for Postoperative Outcome After Spinal Cord Stimulation in Patients With Failed Back Surgery Syndrome

Abstract

Abstract INTRODUCTION Spinal cord stimulation (SCS) has been reported as an effective treatment modality for various pain diseases, and a 10-kHz high-frequency therapy (HF10) is a novel type of SCS with a superiority compared to traditional SCS in chronic back and leg pain. Among indications for SCS, failed back surgery syndrome (FBSS) has a wide variety of etiology such as types of surgery, the level of the previous procedure, and imaging findings, while no previous study has reported possible imaging factors that can predict the postoperative outcome after SCS. METHODS A total of 31 patients were included in this retrospective study. We included patients with FBSS who received first-time HF10 trial between January 2014 and November 2018. Pre- and postoperative pain scores were evaluated by the visual analog scale being rated between 0 and 10. We defined a pain reduction < 50% as treatment failure, and a pain reduction > 80% as an excellent success. We defined the statistical significance as P < .05. RESULTS This study included 3 groups: (1) 10 patients with <2; (2) 10 patients with 2, 3, or 4; and (3) 11 patients with 4 < , of the total number of lumbar stenotic level + disc bulging/herniated level. Regarding the excellent success rate, there is a trend toward significance between three groups (60% vs 30% vs 18% respectively, P = .12), while a significant difference was observed for treatment failure between groups (10% vs 10% vs 55%, respectively, P = .03). The multivariable logistic regression analysis confirmed that lumbar stenotic level + disc bulging/herniated level < 2 was the significant predictive factor for excellent success (OR 11.95, P = .03), and 4 < lumbar stenotic level + disc bulging/herniated level was significant for treatment failure (OR 10.8, P = .01). CONCLUSION Total number of lumbar stenotic level + disc bulging/herniated level is a novel predictive factor for the postoperative outcome in FBSS patients after HF10.