Results from the first prospective study of minimally invasive facet arthrodesis and long-term data on spinal cord stimulation showed that these surgical techniques can achieve pain relief in patients with various back pain conditions, according to a news release from the American Academy of Pain Medicine.
The studies were presented at the AAPM's 26th Annual Meeting in San Antonio, Texas.
In the first study, Daniel Bennett, MD, DABPM, from Integrative Treatment Centers in Denver, Colo., performed the minimally invasive facet arthrodesis procedure on 102 spinal joints in patients with recurrent facet-mediated low back pain. The patients had previously responded to thermal radiofrequency, but their symptoms recurred after an average of 10 months, according to the release.
The surgery consists of a small incision and pins placed by the joints of the area that is causing the patient's back pain, allowing a small drill to enter the joint. A Morse-tapered allograft is then placed into the joint, according to the release. Patients were the placed in a rigid lumbar brace for 16 weeks following surgery. At one year follow-up, pain was reduced from 79 to 23 on a Visual Analog Scale, and function was improved from 33.46 to 8.32 on an Oswetry Disability Index. Additionally, 92 percent of the patients reported discontinuing use of narcotic medications, according to the release. Only four patients' grafts dislodged, but only one of these patients reported continued pain.
The second study examined the addition of spinal cord stimulation to conventional medical management to reduce persistent or recurrent back pain following a lumbosacral spinal surgery to alleviate pain, called Failed Back Surgery Syndrome, according to the release. Researchers evaluated 100 patients suffering from FBSS from 12 centers in different parts of the world, who were randomized into two equal groups. One group received SCS, while the other received CMM. After six months, 48 percent of the SCS group experienced more than 50 percent pain relief as compared to 9 percent in the CMM group. Thirty-eight percent of the SCS group also achieved greater than 30 percent back pain relief in comparison to 14 percent in the CMM group, according to the release.
At the six-month point, 30 patients of the CMM group, who were not satisfied with their group, crossed over to the SCS group, while only four patients from the SCS group crossed to the CMM group.
At two years of follow-up, after excluding patients who were no longer participating in the trial, 42 of the original 50 participants in the SCS group continued on with stimulation while only 11 original patients remained in the CMM group. Leg pain relief improved, the ODI improved and quality of life improved in the SCS group, according to the release.
As a sub-analysis, 34 percent of the SCS group and 59 percent of the CMM group experienced worsening of back pain, which tended to increase in both groups over the course of the day as identified by analysis of the pain diary, according to the release. However, no pattern of daily pain variation could be identified.
Researchers from both studies are now working on multi-center trials of these procedures.
Read the AAPM's release on new techniques for reducing lower back pain.