Abstract
Patients with Failed Back Surgery Syndrome (FBSS) report a considerably lower health- related quality of life (HRQoL), compared to the general population. Spinal cord stimulation (SCS) is an effective treatment to offer pain relief in those patients. Despite initial treatment success of SCS, its effect sometimes wears off over time. This study investigates the added value of high dose SCS (HD-SCS) in patients with unsatisfactory conventional SCS, from a quality of life perspective. Seventy-eight FBSS patients who were treated with conventional SCS that failed to provide pain relief, were recruited in 15 centers. HRQoL was assessed before converting to HD-SCS (baseline) and three times after converting to HD-SCS using the EuroQol-5D-3L. Quality adjusted life years (QALY) were calculated and compared with conventional SCS. An overall significant increase over time was seen in utility values of the EQ5D-3L, as the mean value at baseline 0.283 (±0.21) increased to 0.452 (±0.29) at 12 months of HD-SCS. This average increase in utility coincides with an average increase of 0.153 (±0.24) QALY’s in comparison to continued conventional SCS. Besides the potential of HD-SCS to salvage patients with failed responses to conventional SCS, this treatment seems to be a more efficient treatment than conventional SCS.
Highlights
Failed Back Surgery Syndrome (FBSS) is characterized by persisting back and/or leg pain of unknown origin either persisting despite surgical intervention or appearing after surgical intervention for spinal pain [1]
This study investigates the added value of high dose Spinal cord stimulation (SCS) (HD-SCS) in patients with unsatisfactory conventional SCS, from a quality of life perspective
The SCS system is often explanted and a substantial proportion of these explants happens before 2.25 years of SCS treatment [16,17], the so-called “break-even” point for SCS treatment when compared with conventional medical management (CMM)
Summary
Failed Back Surgery Syndrome (FBSS) is characterized by persisting back and/or leg pain of unknown origin either persisting despite surgical intervention or appearing after surgical intervention for spinal pain [1]. It has shown to be effective in relieving pain, and in improving disability and quality of life [6,7,8,9,10] Due to both the increase in back surgeries with associated FBSS rates and mounting evidence of its effectiveness, SCS has found its way into routine clinical practice. In 20–40% of patients, the initial effectiveness declines over time due to growing central nervous system tolerance [14,15] In this case, the SCS system is often explanted and a substantial proportion of these explants happens before 2.25 years of SCS treatment [16,17], the so-called “break-even” point for SCS treatment when compared with CMM. We investigated real-world data of HRQoL in a large FBSS study population, after failed or unsatisfactory conventional SCS [22]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
