SCS after failed fusion

[NJPAIN]

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Do any of you have a policy that you wait a certain period of time following a lumbar fusion prior to proceeding with an SCS trial? What I am getting out is that if you argue that a fusion has not "failed" until the one year mark has passed do you wait a full year before doing an SCS trial?

 

[NOSfan]

I'll bite:

1st time surgery without h/o long-standing neuropathic symtpoms --> 6-9 months
'Repeat surgery' with h/o of long-standing neuropathic symptoms --> 3-4 months

This is of course, if the clinical picture indicates (patient failed conservative measures in the past including PT, neuromodulating medications or possible ESI)

 

[SeniorWrangler]

With no sarcasm intended, have you ever seen a fusion start working six months post-surgery? No relief, and then six or seven months post-op, everything gets better? I never have. It is usually the reverse with a failed back surgery, a few months of post-op placebo response and then people are back to their preoperative baseline or (usually) worse.

 

[nvrsumr]

With no sarcasm intended, have you ever seen a fusion start working six months post-surgery? No relief, and then six or seven months post-op, everything gets better? I never have. It is usually the reverse with a failed back surgery, a few months of post-op placebo response and then people are back to their preoperative baseline or (usually) worse.

I see this all the time usually about a year later. The SI joints finally stopped hurting.... the casue of the lbp to begin with...

 

[lobelsteve]

I prophylax fusion with pre-op SCS.

 

[drf]

I prefer preop IT pump. That way I can use the access port for the spinal I give for the SCS placement as well as the fusion.