The Evolving Role of High-Frequency Spinal Cord Stimulation as Salvage Therapy in Neurostimulation.

Abstract

High-frequency 10-kHz spinal cord stimulation (10-kHz SCS) has shown promise in multicenter prospective trials for the management of chronic back and leg pain. Traditional spinal cord stimulation (t-SCS) has a long history of effectiveness in chronic neuropathic syndromes but not uncommonly can fail to provide long-term relief, leaving a significant group of patients with unsatisfactory outcomes. There is mounting evidence that 10-kHz SCS may offer relief in this subset of patients. The purpose of this retrospective analysis was to report a single-institution long-term experience of 10-kHz SCS in patients who did not get adequate pain relief with prior t-SCS devices. A temporary trial of 10-kHz SCS was carried out for 7days, and those experiencing an average of 50% reduction in pain intensity underwent implantation. Patients were classified as moderate responders if relief was 31% to 50% and excellent responders if pain relief exceeded 50%. Thirty-one patients who had experienced failed t-SCS primarily from poor paresthesia coverage underwent a trial of 10-kHz SCS and 29 underwent implantation. Twenty-eight patients were available for analysis, with 57.1% experiencing 30% response and 46.4% experiencing excellent response at a median follow-up of 21.2(±8.4) months. This small single-institution study suggests that a significant proportion of patients with previously failed t-SCS may achieve clinically meaningful and durable pain relief with 10-kHz SCS.