Spinal Cord Stimulation versus Repeated Lumbosacral Spine Surgery for Chronic Pain: A Randomized, Controlled Trial

TLDR

Persistent radicular pain after lumbosacral spine surgery is commonly caused by nerve root compression and is traditionally managed with repeated surgery or, as a last resort, spinal cord stimulation (SCS). The study prospectively randomized 50 patients to SCS or reoperation to determine whether SCS yields superior pain relief and treatment outcomes over a three‑year follow‑up. Patients were followed for an average of three years by blinded interviewers, with success defined by self‑reported pain relief and satisfaction, and crossover to the alternative procedure recorded as an outcome; analgesic use, activities of daily living, and work status were also self‑reported. SCS achieved higher success rates (9/19 vs 3/26, P < 0.01), lower crossover (5/24 vs 14/26, P = 0.02), and reduced opioid use compared to reoperation, with no significant difference in activities of daily living or work status, indicating SCS is more effective for persistent radicular pain.

Abstract

Persistent or recurrent radicular pain after lumbosacral spine surgery is often associated with nerve root compression and is treated by repeated operation or, as a last resort, by spinal cord stimulation (SCS). We conducted a prospective, randomized, controlled trial to test our hypothesis that SCS is more likely than reoperation to result in a successful outcome by standard measures of pain relief and treatment outcome, including subsequent use of health care resources.For an average of 3 years postoperatively, disinterested third-party interviewers followed 50 patients selected for reoperation by standard criteria and randomized to SCS or reoperation. If the results of the randomized treatment were unsatisfactory, patients could cross over to the alternative. Success was based on self-reported pain relief and patient satisfaction. Crossover to the alternative procedure was an outcome measure. Use of analgesics, activities of daily living, and work status were self-reported.Among 45 patients (90%) available for follow-up, SCS was more successful than reoperation (9 of 19 patients versus 3 of 26 patients, P <0.01). Patients initially randomized to SCS were significantly less likely to cross over than were those randomized to reoperation (5 of 24 patients versus 14 of 26 patients, P=0.02). Patients randomized to reoperation required increased opiate analgesics significantly more often than those randomized to SCS (P <0.025). Other measures of activities of daily living and work status did not differ significantly.SCS is more effective than reoperation as a treatment for persistent radicular pain after lumbosacral spine surgery, and in the great majority of patients, it obviates the need for reoperation.