Spinal Cord Stimulation for Patients with Failed Back Surgery Syndrome: A Systematic Review

Background: Failed back surgery syndrome is common in the United States. Management of post lumbar surgery syndrome with multiple modalities includes interventionaltechniques, resulting in moderate improvement, leaving a proportion of patients in intractable pain. The systematic reviews of long-term benefits and risks of spinal cord stimulation(SCS) for patients with failed back surgery syndrome showed limited to moderate evidenceand cost effectiveness. However, with the exponential increase in surgery in the UnitedStates, spinal cord implants are also increasing. Thus, the discussion continues with claimsof lack of evidence on one hand and escalating increases in utilization on the other hand.Study Design: A systematic review of SCS in patients with failed back surgerysyndrome.Objectives: This systematic review is undertaken to examine the evidence from randomized controlled trials (RCTs) and observational studies to evaluate the effectiveness of SCSin post lumbar surgery syndrome and to demonstrate clinical and cost effectiveness.Methods: Review of the literature was performed according to the Cochrane Musculoskeletal Review Group Criteria as utilized for interventional techniques for randomized trials and the Agency for Healthcare Research and Quality (AHRQ) criteria for observational studies.The 5 levels of evidence were classified as Level I, II, or III with 3 subcategories in LevelII based on the quality of evidence developed by the U.S. Preventive Services Task Force(USPSTF).Data sources included relevant literature of the English language identified throughsearches of PubMed and EMBASE from 1966 to December 2008, and manual searchesof bibliographies of known primary and review articles.Outcome Measures: The primary outcome measure was pain relief (short-term relief≤ one-year and long-term > one-year). Secondary outcome measures of improvement infunctional status, psychological status, return to work, and reduction in opioid intake wereutilized.Results: The indicated evidence is Level II-1 or II-2 for long-term relief in managing patients with failed back surgery syndrome.Limitations: The limitations of this review included the paucity and heterogeneity ofthe literature.Conclusion: This systematic review evaluating the effectiveness of SCS in relievingchronic intractable pain of failed back surgery syndrome indicated the evidence to beLevel II-1 or II-2 for clinical use on a long-term basis.Key words: Chronic low back pain, neuropathic pain, failed back surgery syndrome,FBSS, post lumbar surgery syndrome, electrical stimulation, spinal cord stimulation