SCS for FBSS with predominantly axial back pain...

[EtherBunny]

Just curious about other attending physicians' experiences with a particular subset of patients with FBSS: no major psychiatric comorbidities, predominantly axial back pain, no issues with pre-existing hardware that merit surgical correction, history of failure with procedures directed at levels adjacent to fusion (i.e., procedures directed at facets or epidural steroid injections), unresponsive to physical therapy, and refractory to pharmacotherapy.

Any long term success with SCS on this subset of patients? If so, what vendors are you using and are you opting exclusively for high frequency at this point? What are your long term outcomes?

Any thoughts or pearls of wisdom out there on this lovely subset of patients?

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[Taus]

My n=2, both nevro. Both 2-3 months out doing well and happy. Long term tbd.... never done Scs for pure axial before that (I avg about 1 Scs/month x 3 years)


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[EtherBunny]

My n=2, both nevro. Both 2-3 months out doing well and happy. Long term tbd.... never done Scs for pure axial before that (I avg about 1 Scs/month x 3 years)


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Thanks for the reply! I've never done any SCS for pure axial coverage either. I've done a ton of it for radicular pain but never for purely axial low back pain. I'm curious if anyone else on this forum has any positive experience with it, especially in the long term.

 

[gdub25]

We did several of my fellowship last year and they all did very well. It completely changed our thoughts on stimulation for axial back pain and we started our free trials of patients that we never would've considered candidates before. We used Nevro for all of them. Their study shows good results for axial back pain and in the patients we did we saw similar outcomes. I've graduated and been out in private practice for about six months now that most of these patients were implanted about a year ago and the reports I get for my training program or that they are still doing well.

 

[lobelsteve]

We did several of my fellowship last year and they all did very well. It completely changed our thoughts on stimulation for axial back pain and we started our free trials of patients that we never would've considered candidates before. We used Nevro for all of them. Their study shows good results for axial back pain and in the patients we did we saw similar outcomes. I've graduated and been out in private practice for about six months now that most of these patients were implanted about a year ago and the reports I get for my training program or that they are still doing well.

They all did well means you did not have adequate longitudinal follow up.

 

[EtherBunny]

Yeah, my principal concern is long term effectiveness. Steve, have you had any negative experiences with high frequency SCS to treat axial back pain?

 

[lobelsteve]

Yeah, my principal concern is long term effectiveness. Steve, have you had any negative experiences with high frequency SCS to treat axial back pain?

No negatives yet. It works well in most patients. 3 trials since I started have failed. Was hoping it was lead migration in trial and now we have every one get up bend, twist, and then lay down for repeat Xray before programming.

 

[BobBarker]

Some people just need to feel the buzz..
Did you retrial any of them with traditional?

 

[lobelsteve]

Some people just need to feel the buzz..
Did you retrial any of them with traditional?

Nope, I'm a fan of 1 bite at that apple.

 

[Ducttape]

but what if it is a Honeycrisp apple? hard to take just 1 bite

 

[101N]

What if you are paid for the second bite? Doesn't that create 'moral hazzard' or temptation to take the second bite, even if it doesn't taste good?

 

[ampaphb]

What if you are paid for the second bite? Doesn't that create 'moral hazzard' or temptation to take the second bite, even if it doesn't taste good?

Only if you're feral. Of course, if you have a world view that everyone is mercenary except me, then you might have an alternate perspective.

If you're in the pocket of the insurance carriers, you wouldn't even bother taking the first bite.

 

[ampaphb]

Nope, I'm a fan of 1 bite at that apple.

That seems self defeating. Assuming HF is different from tonic stim, why would you deny the patient an alternative technology, just because your preferred method was unsuccessful.

Unless, of course, you believe that HF captures ALL patients that would have responded to tonic stim

 

[lobelsteve]

That seems self defeating. Assuming HF is different from tonic stim, why would you deny the patient an alternative technology, just because your preferred method was unsuccessful.

Unless, of course, you believe that HF captures ALL patients that would have responded to tonic stim

My next failed Nevro trial gets a few days of St Jude.