2120 Spinal Cord Stimulation for the Treatment of Post-Operative Pain in the Setting of Complex Thoracolumbar Spinal Surgery: Preliminary Results of a Pilot Study

INTRODUCTION: Spinal cord stimulation has been used for decades to treat chronic back and extremity pain, especially in the context of failed back syndrome. To date, however, little has been described regarding the application of spinal cord stimulation to treat acute pain. This study summarizes the author's experience with the institution of spinal cord stimulation in the immediate post-operative period in the context of complex thoracolumbar spinal surgery as a method of improving patient satisfaction and pain relief. This pilot study represents the first report of the application of spinal cord stimulation for the treatment of acute post-operative spinal surgery pain. METHODS: A retrospective review was performed under local IRB approval of all adult patients who underwent complex thoracolumbar reconstructive spinal surgery with immediate post-operative spinal cord stimulation. All cases were performed by a single surgeon, the author, between March 2019 through December 2021. At the completion of the spinal surgical procedure but before surgical site closure, one to two percutaneous cylindrical spinal cord stimulation trial leads (Octrode, Abbott Medical) were inserted under direct vision into the dorsal epidural space between the lumbar 1 and lumbar 3 laminectomy site, and fluoroscopically directed in a cephalad direction into the inferior thoracic spinal canal (superior lead contact ranging from thoracic 8 to 11 levels). Lead wires were routed out through separate skin puncture sites. Stimulation was initiated on post-operative day 1. RESULTS: Nine patients underwent the stimulation procedure (5 male), ranging from 52 to 88 years old. Seven of the 9 cases were revision procedures, and number of segments fused ranged from 2 to 11. Duration of stimulation ranged from 4 to 6 days (mean 4.44). Seven of 9 patients stated that stimulation definitely helped with post-operative pain relief, with the remaining 2 patients undecided as to efficacy. No patient reported that stimulation made their pain worse. Four of the 9 patients ultimately converted to a permanent implant. No episodes of cerebrospinal fluid leak or epidural hematoma were observed. One patient with known immunosuppression presented 3 weeks after surgery with a superficial wound cellulitis, from which bacteriologic cultures were negative. CONCLUSIONS: The application of neuromodulation in the form of dorsal column epidural spinal cord stimulation holds promise as a potential adjunctive method of controlling intense post-operative pain. The insertion of the electrodes at the conclusion of surgery takes minimal additional time and is well-tolerated and effective. In addition, this technique holds out hope for reducing narcotic requirements in this challenging patient population.