Spinal Cord Stimulation in Failed Back Surgery Syndrome: Effects on Posture and Gait-A Preliminary 3D Biomechanical Study

L Brugliera, A De Luca, S Corna, M Bertolotto, G A Checchia, M Cioni, P Capodaglio, C Lentino, L Brugliera, A De Luca, S Corna, M Bertolotto, G A Checchia, M Cioni, P Capodaglio, C Lentino

Abstract

We studied 8 patients with spinal cord stimulation (SCS) devices which had been previously implanted to treat neuropathic chronic pain secondary to Failed Back Surgery Syndrome. The aim of our study was to investigate the effects of SCS on posture and gait by means of clinical scales (Short Form Health Survey-36, Visual Analogue Scale for pain, and Hamilton Depression Rating Scale) and instrumented evaluation with 3D Gait Analysis using a stereophotogrammetric system. The latter was performed with the SCS device turned both OFF and ON. We recorded gait and posture using the Davis protocol and also trunk movement during flexion-extension on the sagittal plane, lateral bending on the frontal plane, and rotation on the transversal plane. During and 30 minutes after the stimulation, not only the clinical scales but also spatial-temporal gait parameters and trunk movements improved significantly. Improvement was not shown under stimulation-OFF conditions. Our preliminary data suggest that SCS has the potential to improve posture and gait and to provide a window of pain-free opportunity to optimize rehabilitation interventions.

Figures

Figure 1
Figure 1
Reference points for the markers placed for the trunk motion task. SIPS, superior iliac posterior spine; ACR, acromion.
Figure 2
Figure 2
Changes in GRF peak values on both sides under ON and OFF conditions.
Figure 3
Figure 3
Improvements in cervical and dorsal spine ROM in lateral bending on both sides during ON.

References

    1. Elliott A. M., Smith B. H., Penny K. I., Smith W. C., Chambers W. A. The epidemiology of chronic pain in the community. The Lancet. 1999;354(9186):1248–1252. doi: 10.1016/s0140-6736(99)03057-3.
    1. Breivik H., Collett B., Ventafridda V., Cohen R., Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. European Journal of Pain. 2006;10(4):287–333. doi: 10.1016/j.ejpain.2005.06.009.
    1. Dworkin R. H., Backonja M., Rowbotham M. C., et al. Advances in neuropathic pain: diagnosis, mechanisms, and treatment recommendations. Archives of Neurology. 2003;60(11):1524–1534. doi: 10.1001/archneur.60.11.1524.
    1. Thomson S., Jacques L. Demographic characteristics of patients with severe neuropathic pain secondary to failed back surgery syndrome. Pain Practice. 2009;9(3):206–215. doi: 10.1111/j.1533-2500.2009.00276.x.
    1. Doth A. H., Hansson P. T., Jensen M. P., Taylor R. S. The burden of neuropathic pain: A systematic review and meta-analysis of health utilities. Pain. 2010;149(2):338–344. doi: 10.1016/j.pain.2010.02.034.
    1. Kumar K., Taylor R. S., Jacques L., et al. Spinal cord stimulation versus conventional medical management for neuropathic pain: A multicentre randomised controlled trial in patients with failed back surgery syndrome. Pain. 2007;132(1-2):179–188. doi: 10.1016/j.pain.2007.07.028.
    1. Zucco F., Ciampichini R., Lavano A., et al. Cost-Effectiveness and Cost-Utility Analysis of Spinal Cord Stimulation in Patients With Failed Back Surgery Syndrome: Results From the PRECISE Study. Neuromodulation. 2015;18(4):266–276. doi: 10.1111/ner.12292.
    1. Mailis-Gagnon A., Furlan A. D., Sandoval J. A., Taylor R. Spinal cord stimulation for chronic pain. Cochrane Database of Systematic Reviews. 2004;(3)CD003783
    1. Rijken N. H., Vonhögen L. H., Duysens J., Keijsers N. L. The effect of spinal cord stimulation (SCS) on static balance and gait. Neuromodulation. 2013;16(3):244–250. doi: 10.1111/j.1525-1403.2012.00512.x.
    1. Buonocore M., Demartini L., Bonezzi C. Lumbar spinal cord stimulation can improve muscle strength and gait independently of the analgesic effect: A case report. Neuromodulation. 2006;9(4):309–313. doi: 10.1111/j.1525-1403.2006.00072.x.
    1. Ware J. E., Sherbourne C. D. The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical Care. 1992;30(6):473–483. doi: 10.1097/00005650-199206000-00002.
    1. Dixon J. S., Bird H. A. Reproducibility along a 10 cm vertical visual analogue scale. Annals of the Rheumatic Diseases. 1981;40(1):87–89. doi: 10.1136/ard.40.1.87.
    1. Hamilton M. A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry. 1960;23:56–62. doi: 10.1136/jnnp.23.1.56.
    1. Davis R. B., III, Õunpuu S., Tyburski D., Gage J. R. A gait analysis data collection and reduction technique. Human Movement Science. 1991;10(5):575–587. doi: 10.1016/0167-9457(91)90046-Z.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit