Objective: Spinal cord stimulation is used for
treating failed back surgery syndrome, chronic
arachnoiditis, peripheral neuropathies, postamputation
phantom pain, complex regional pain syndrome and
pain secondary to spinal cord injury. In this study we
present 7 cases with intractable neuropathic radicular
pain which developed following spine surgery.
 Material and Methods: Spinal cord stimulation
was applied to 7 (3male/4 female) patients who had
failed back surgery syndrome and pain resistant to
medical and invasive methods, with the council
decision, which included neurosurgery, neurology,
and psychiatry. One week stimulation trial was
applied to all cases.
 Results:The mean age of the patients was
54.85±7.64 years. The mean of pain intensity in
Visual Analog Scale was 8.71±0.74 at preoperative
status and post operative pain intensity was 2.27±0.67
at 6 months. Pain intensity significantly decreases
after spinal cord stimulation (p=0.000). One of the
three cases who had unsuccessful trial period received
morphine pump implantation, and percutaneous
lumbar sympathectomy was applied to another one.
One case who received permanent implantation was
replaced to another location due to skin erosion. There
was no morbidity.
Conclusion: Spinal cord stimulation is an effective
tool in reducing pain, in patients who have
unsuccessful lower back surgery with the correct
indications

Acar, F.

Acar, G.

Altuğ, Filiz

Ciobanu, D.

Kızılay, Z.

Yılmaz, A.

Pamukkale Üniversitesi Açık Erişim Arşivi

VOL.19/ ISSUE 32/ 2013__________                        __   ___ROMANIAN JOURNAL OF PHYSICAL THERAPY 
26 
 
        Key words: unsuccessful lower back surgery, 
neuropathic pain, spinal cord stimulation 
 
        Abstract 
        Objective: Spinal cord stimulation is used for 
treating failed back surgery syndrome, chronic 
arachnoiditis, peripheral neuropathies, postamputation 
phantom pain, complex regional pain syndrome and 
pain secondary to spinal cord injury.  In this study we 
present 7 cases with intractable neuropathic radicular 
pain which developed following spine surgery. 
         Material and Methods: Spinal cord stimulation 
was applied to 7 (3male/4 female) patients who had 
failed back surgery syndrome and pain resistant to 
medical and invasive methods, with the council 
decision, which included neurosurgery, neurology, 
and psychiatry. One week stimulation trial was 
applied to all cases. 
        Results:The mean age of the patients was 
54.85±7.64 years. The mean of pain intensity in 
Visual Analog Scale was 8.71±0.74 at preoperative 
status and post operative pain intensity was 2.27±0.67 
at 6 months.  Pain intensity significantly decreases 
after spinal cord stimulation (p=0.000).  One of the 
three cases who had unsuccessful trial period received 
morphine pump implantation, and percutaneous 
lumbar sympathectomy was applied to another one. 
One case who received permanent implantation was 
replaced to another location due to skin erosion. There 
was no morbidity. 
Conclusion: Spinal cord stimulation is an effective 
tool in reducing pain, in patients who have 
unsuccessful lower back surgery with the correct 
indications. 
         Cuvinte cheie: interveníe chirurgicală nereuşită, 
coloana lombară, durere neuropatică, stimulare 
medulară 
 
       Rezumat:  
        Introducere: Stimularea medulară este folosită 
pentru tratarea intervenţiilor chirurgicale nereuşite la 
nivelul coloanei lombare, a arahnoiditei cornice, a 
neuropatiilor periferice, durerii postamputaţie, 
sindromul durerii regionale şi a durerii consecutive 
unui traumatism vertebro-medular.  
        Scop: În acest studiu prezentăm 7 cazuri de 
durere intractabilă radiculară neuropatică, consecutivă 
intervenţiei chirurgicale pe coloană. 
        Material şi Metode: Stimularea medulară s-a 
aplicat la 7 pacienţi ( 3 bărbaţi/4 femei), cu sindrom 
dureros concecutiv unor intervenţii chirurgicale 
nereuşite la nivelul coloanei, rezistent la tratament 
medicamentos şi invaziv şi care include  
neurochirurgie,  tratament neurologic şi psihiatric. In 
toate cazurile s-a aplicat o săptămână de stimulare 
medulară. 
        Rezultate: Media de vârstă a pacienţilor este de 
54.85±7.64 ani. Media intensităţii durerii pe Scala 
Analogă Vizuală a fost de 8.71±0.74 preoperator iar 
postoperator aceasta a fost de 2.27±0.67, la 6 luni. 
Intensitatea durerii se reduce semnificativ după 
stimularea medulară (p=0.000). Unul dintre trei cazuri 
de intervenţie nereuşită au beneficiat de implantarea 
unei pompe cu morfină, iar altui pacient i s-a efectuat 
simpatectomie lombară laparoscopică. Într-un caz la 
care s-a efectuat implantare permanentă s-a schimbat 
locaţia datorită eroziunilor cutanate. Nu a existat 
mortalitate. 
Concluzii: Stimularea medulară este un instrument 
util în lupta pentru reducerea durerii, la pacienţii cu 
intervenţie chirurgicală nereuşiră la nivelul coloanei 
lombare, cu indicaţii corecte. 
    
SPINAL CORD STIMULATION IN FAILED BACK SURGERY 
 
STIMULAREA COLOANEI VERTEBRALE ÎN INTERVENŢIILE 
CHIRURGICALE EŞUATE 
 
Ali Yilmaz1, Zahir Kizilay2, Filiz Altug3, 
Doriana Ciobanu4, Göksemin Acar5, Feridun Acar6 
__________________________________________________________________ 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
_________________________________________________________________________ 
 
                                                        
 
1
 MD, Pamukkale University, Departmant of Neurosurgery, Denizli,Turkey 
2
 MD, Pamukkale University, Departmant of Neurosurgery, Denizli,Turkey  
3Assist. Prof, Pamukkale University, School of Physical Therapy and Rehabilitation.Denizli, Turkey. 
Corresponding author: Filiz ALTUĞ 
Address: Pamukkale Üniversitesi Fizik Tedavi ve Rehabilitasyon Yüksek Okulu Rektörlük Binası B Katı Denizli, 
Turkey; Email: fkural@pau.edu.tr; Phone: 05355625146 
4
 Assist. Prof., Oradea University, Department of Physical Therapy, Oradea, Romania 
5
 Assoc. Prof, Pamukkale University, Medical School, Department of Neurology.Denizli, Turkey 
6
 Assoc. Prof, MD, Pamukkale University, Departmant of Neurosurgery, Denizli,Turkey 
 VOL. 19/ NR 32/ 2013         REVISTA ROMÂNĂ DE KINETOTERAPIE 
27 
 
Introduction 
Failed back surgery syndrome (FBSS, post laminectomy syndrome) is described as 
continuance or occurrence of pain due to various reasons after surgical treatment. [1]  
Whatever the surgical procedure is, a small percentage of patients are experiencing 
chronic back-leg pain. For most of the postoperative complications, it is possible to find an 
organic reason (foraminal stenosis, spinal stenosis, false level surgery, recurrent disc, painful 
disc disease, neuropathic pain, etc.). Even though the causes are different for these conditions, 
they are classified under failed back surgery syndrome. [2,3,4] 
Treatment of chronic back pain is difficult on a patient who did not benefit from surgery. 
This patient population must be assessed in a multidisciplinary fashion that will decrease the 
complications. Various diagnostic and therapeutic minimally invasive procedures are performed 
on several steps in failed back surgery syndrome. [4,5] 
Spinal cord stimulation is an acceptable method of treatment in medicallyintractable 
neuropathic pain [6, 7]. Its main effect is via Melzack and Wall’s door control mechanism. In 
addition to this property, suppression of tactile allodynia, prevention from peripheral ischemia, 
inhibition of dorsal horn by GABA is also present with this approach [8, 9]. General indications 
include failed back surgery, periphery ischemia, complex regional pain syndrome, phantom pain, 
resistant and non-operative radiculopathy, posth erpetic neuralgia and resistant symptomatic 
ischemic heart diseases [9, 10]. 
This study aims to evaluate effectiveness of spinal cord stimulation on failed back 
surgery syndrome patients who have intractable pain. 
 
Materials and method 
This study was performed according to the Declaration of Helsinki. All patients were 
extensively informed and provided written consent before the following treatment. 
Spinal cord stimulation was applied to 7 (3 male/4 female) patients who had failed back 
surgery syndrome and pain resistant to medical and invasive methods with the council decision 
which included neurosurgeon, neurologist, and psychiatrist. Pain was evaluated with Visual 
Analog Scale (VAS). 1 week stimulation trial was applied to all cases using Medtronic 
percutaneous oktade lead. 4 patients who had pain relief over 50% received permanent 
implantations. Stimulation began on an appropriate dermatome region and adequate voltage 
adjustments were done after sufficient pain control was achieved. 
 
Results 
The mean age of the patients was 54.85±7.64 years. The mean of pain intensity in VAS 
(Visual Analog Scale) was 8.71±0.74 preoperatively and postoperative pain intensity was 
2.27±0.67 at 6 months. Pain intensity has decreased significantly after spinal cord stimulation 
(p=0.000).   
For 3 ineffective cases, one had morphine pump implantation and one had percutaneous 
lumbar sympathectomy. Generator was removed to another location due to skin erosions on the 
case that had permanent implantation. None of the cases experienced permanent morbidity.  
 
Discussion 
Spinal cord stimulation has become a popular neuromodulator procedure for failed back 
surgery cases in order to achieve pain management. Beside from being reversible and minimally 
invasive, it also decreases the pain killer applications, pain intensity and frequency and increases 
physical activity and life quality [11,12,13,14].  
As a result of this study, 4 cases that had permanent implantation after trial period 
experienced significantly less pain after 6 months (p=0.000). 
Turner et al. evaluated spinal cord stimulation for pain intensity, medication dosage, 
functional state and working capacity on 51 failed back syndrome cases. Within the first 6 
months after the application, they observed decrease in leg pain and morphine use and increase 
VOL.19/ ISSUE 32/ 2013__________                        __   ___ROMANIAN JOURNAL OF PHYSICAL THERAPY 
28 
 
functional capacity. They also reported that opioid usage has decreased significantly in 
postoperatively 12 months [15]. Another study divided FBSS cases into 3 groups and applied 
spinal cord stimulation to 51, medical treatment to 39 and no treatment to 68 cases. Cases were 
compared for pain intensity, disability status and opioid usage. As a result, spinal cord 
stimulation was found to be more expensive but more effective in decreased pain intensity and 
disability [16]. One study observed 35 patients (complex regional pain syndrome and FBSS) for 
4.4 years and evaluated pain intensity and life quality. More than half of the cases in complex 
regional pain syndrome expressed a decrease of 50% in pain intensity after 4.4 years; 
furthermore, FBSS cases expressed a decrease of 50% in pain intensity after 3.8 years [17]. 
We present early period results on our study. VAS scores for pain intensity have 
decreased from 8.71±0.74 to 2.27±0.67 6 months postoperatively. 
Spinal cord stimulation for failed back surgery syndrome also shows promising results in 
the long term [17,18]. Abeloos et al. observed 55 FBSS patients for 8.3 for treatment satisfaction 
and life quality and reported 50% decrease of pain intensity in 75% of the patients. In addition, 
sitting, getting up from bed and going up from stairs have improved 75% and walking has 
improved 82%. Medication usage has decreased 66% in 50% of the patients [19]. 
There are plenty of studies in the literature explaining effectiveness of spinal cord 
stimulation [18, 19, 20, 21]. On our study we presented or preliminary experiences. Limitations 
of our study include evaluating only pain, limited patient number and short follow-up period. 
 
Conflict of Interest Disclosure: There is no any conflict of interest 
 
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Spinal cord stimulation in failed back surgery

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Spinal cord stimulation in failed back surgery

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