title: Back pain:  a real target for spinal cord stimulation?
abstract: BACKGROUND
  Failed back surgery syndrome represents one of the most frequent etiologies of chronic back pain and is a major public health issue. Neurostimulation has currently not been validated in the treatment of back pain because of technological limitations in implantable spinal cord stimulation (SCS) systems. New-generation leads using several columns of stimulation can generate longitudinal and/or transverse stimulation fields into the spinal cord.
  
  
  OBJECTIVE
  To investigate, through extensive stimulation testing, the capacity of multicolumn tripolar leads to achieve back territory paresthesia coverage in refractory failed back surgery syndrome patients.
  
  
  METHODS
  Eleven patients implanted with a 16-contact spinal cord stimulation lead (Specify 5-6-5, Medtronic Inc) were assessed with a systematic exploration of 43 selected stimulation configurations to generate bilateral back paresthesia in addition to leg territory coverage.
  
  
  RESULTS
  The tripolar lead successfully generated paresthesia in both bilateral back and leg territories in 9 patients (81.8%). Success rates of multicolumn stimulation patterns were significantly higher than for longitudinal configurations for lombodorsal paresthesia coverage. Six months after implantation, significant pain relief was obtained compared with preoperative evaluation for global pain (Visual Analog Scale, 2.25 vs 8.2 preoperatively; P < .05), leg pain (Visual Analog Scale, 0.5 vs 7.6 preoperatively; P < .05), and back pain (Visual Analog Scale, 1.5 vs 7.8 preoperatively; P < .05).
  
  
  CONCLUSIONS
  These results suggest that multicolumn leads can reliably generate back pain coverage and favor pain relief outcomes. This may lead physicians to reconsider new indications for spinal cord stimulation. Expanding neurostimulation perspectives to intractable back pain syndromes could become realistic in the near future.
authors.affiliation: Department of Neurosurgery, Poitiers University School of Medicine, Poitiers, France. p.rigoard@chu-poitiers.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Rigoard
authors.forename: Alexandre
authors.initials: A
authors.lastname: Delmotte
authors.forename: Samuel
authors.initials: S
authors.lastname: D'Houtaud
authors.forename: Lorraine
authors.initials: L
authors.lastname: Misbert
authors.forename: Bakari
authors.initials: B
authors.lastname: Diallo
authors.forename: Aline
authors.initials: A
authors.lastname: Roy-Moreau
authors.forename: Sylvain
authors.initials: S
authors.lastname: Durand
authors.forename: Solène
authors.initials: S
authors.lastname: Royoux
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Giot
authors.forename: Benoit
authors.initials: B
authors.lastname: Bataille
mesh_terms: D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000379:methods* / Q000592:standards; D004567:Electrodes, Implanted / Q000592:standards; D055111:Failed Back Surgery Syndrome / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D010148:Intractable Pain / Q000628:therapy; D010292:Paresthesia / Q000628:therapy; D017060:Patient Satisfaction; D015203:Reproducibility of Results