Evaluation of Pre-operational Factors Contributing to a Dorsal Column Stimulator Explantation

Objectives Implantation of a dorsal column stimulator (DCS) for axial spine and radicular pain is a commonly performed procedure. Despite the benefits of this device to reduce pain and improve quality of life, some patients elect to have the device explanted. The purpose of this study is to describe pre-operational factors among patients who elected to have their DCS explanted and how these factors are associated with reason for explantation. Materials and Methods We conducted a retrospective descriptive study using the database of a private outpatient orthopedic clinic. We included all patients who had a dorsal column stimulator explanted between January 1, 2007 and June 19, 2014. Data was collected on patient demographics, past medical and back surgery history, as well as details of implantation, permanent device implantation, and subsequent explantation. Reasons for explantation were categorized as: inadequate pain control using three categories (with no device-related pain/discomfort, with device-related pain/discomfort, or inadequate pain control and patient wants MRI), or pain resolved. Results A consecutive sample of 100 subjects who underwent explantation of a DCS was identified for review. Of these 100 subjects, 14 were excluded. Based on our data, we hypothesize that sex (57% female, 43% male) degenerative disc disease (72%), previous back surgery (70%), BMI classified as overweight (subject average = 28.3), history of tobacco usage (57%), and history of narcotic use (80%) may be potential risk factors for explantation. Conclusions With respect to clinical evaluation of patients as candidates for spinal cord stimulator implantation, we cannot recommend that any of the evaluated variables be considered a contraindication to proceeding with a trial procedure. Future studies are planned to compare these data to a control group of subjects to establish risk factors predisposing individuals to explantation of a DCS. Key words: DCS, neurostimulator, spine, pain, explantation

Efficacy of electroacupuncture in patients with failed back surgery syndrome: study protocol for a randomized controlled trial

Background Persistent pain following back surgery called failed back surgery syndrome remains a major treatment challenge. The aim of this study is to evaluate the efficacy and safety of electroacupuncture on relieving back pain in FBSS patients. Methods/design This is a randomized, single-blind, single-site, placebo-controlled trial. A total of 144 eligible FBSS patients will be randomly assigned to the electroacupuncture, manual acupuncture, or sham acupuncture group in a 1:1:1 ratio. Each group will receive 2 treatment sessions per week for 12 weeks. The primary outcome will be low back pain intensity based on the 11-point numerical rating scale (NRS). The secondary outcomes include Oswestry Disability Index (ODI) questionnaire, Beck Depression Inventory-II (BDI-II), Pittsburgh Sleep Quality Index (PSQI), and analgesic consumption. All clinical outcomes will be collected at baseline, during the treatment phase (at 8 and 12 weeks), and at the 16-, 24- and 36-week follow-ups. All data will be analyzed based on the intention-to-treat principle and adverse events will be assessed during the trial. Discussion This pilot randomized controlled trial will evaluate the efficacy of electroacupuncture for treating failed back surgery syndrome. The outcomes will determine whether electroacupuncture is efficacious in relieving low back pain as well as improving the quality of life in failed back surgery syndrome patients. Trial registration Chinese Clinical Trial Registry ChiCTR2000040144. Registered on 22 November 2020

Prevalence of Kinesiophobia in Post Spinal Surgery Patients

Background: The spinal column is a highly complex system of bones and connective tissues that provide support for the body and protect the delicate spinal cord and nerves. Back surgery carries higher risks than some other types of surgery because it is done closer to the nervous system. The most serious of these risks include paralysis and infections. Fear of movement/(re)injury is described as “a specific fear of movement and physical activity that is (wrongfully) assumed to cause reinjury”. In the extreme situation of fear of movement, the expression “kinesiophobia” is used. Tampa Scale for Kinesiophobia (TSK) was developed by Miller, Kori and Todd 1990 in order to assess fear of movement/(re)injury. It is a valid, reliable tool is used to assess Kinesiophobia.(1) Aim: The present study was done to Assess Prevalence of Kinesiophobia In patients undergone Spinal Surgery using Tampa Scale (6- 10 weeks post surgery). Method: In this study a total of 100 patients answered Tampa scale of kinesiophobia and were evaluated according to their level of kinesiophobia after post spinal surgical period 6- 10 weeks, that is after the healing period. Result: There was a high degree of kinesiophobia which was observed after post spinal surgical period 6-10 weeks in 61% of the participants. Conclusion: This study showed Prevalence of High Degree of Kinesiophobia noted after 6-10 weeks in 61% of the Post- Spinal Surgery patients even after 4-6 weeks of healing period. Key words: Kinesiophobia, Fear-avoidance, Spinal surgery, Tampa scale.