TREATMENT OF CHRONIC LOW-BACK AND RADICUL AR PAIN BY SPINAL-CORD STIMULATION - LONG-TERM RESULTS

Seventy-seven patients with chronic, refractory, low back and radicula r pain underwent implantation of a spinal cord stimulator between 1984 and 1992. Most patients had failed back surgery syndrome. In every ca se, an epidural quadripolar ''Resume'' electrode was implanted surgica lly. Results were evaluated after three months then after six to 98 mo nths (mean follow-up 42 months). Long-term efficacy was good in 63.6% of cases, fair in 22%, and poor in 6.5%; treatment failure occurred in 7.9% of cases. Adverse events included one case of meningitis, two ca ses of local infection, and one case each of cerebrospinal fluid fistu la and necrosis of the skin overlying the stimulator. The main causes of treatment failure were complications, inappropriate patient selecti on, and the escape phenomenon. The results of this study demonstrate t hat spinal cord stimulation is effective for the treatment of chronic low back and radicular pain in carefully selected patients; scrupulous application of restrictive selection criteria is essential to the suc cess of the method.