Results from the first prospective study of minimally invasive facet arthrodesis and long-term data on spinal cord stimulation demonstrate the viability of these options to achieve pain relief in patients with various back pain conditions. The studies were presented today at the American Academy of Pain Medicine's 26th Annual Meeting in San Antonio, TX.
In the first study, Daniel Bennett, MD, DABPM, from Integrative Treatment Centers in Denver, Colorado performed the minimally invasive facet arthrodesis procedure on 102 spinal joints in patients with recurrent facet-mediated (joint) low back pain. The patients had previously responded to thermal radiofrequency (a procedure using heat which cuts off the supply of nerves near the site of the back pain) but their symptoms recurred after an average of 10 months. The goal of studying facet arthrodesis was to see if this treatment method could reduce pain, increase function, and reduce the use of medicines for a longer -- hopefully permanent -- duration.
During the surgery, a small incision was made and pins were 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 (bone graft) was then placed into the joint. This technique minimizes disruption of muscles or ligaments, which is often the cause of pain for many patients post-surgery. The graft grew directly into the joint, creating a fusion and thereby relieving pain.
Following the procedure, subjects were placed in a rigid lumbar brace for 16 weeks. At the one year follow-up, pain was reduced from 79 to 23 on a Visual Analog Scale (VAS) and function was improved from 33.46 to 8.32 on an Oswetry Disability Index (ODI). Both VAS and ODI are commonly used measurement tools to assess pain. In addition, 92 percent of the patients reported discontinuing use of narcotic medications. Only four patients' grafts dislodged, but only one of these patients reported continued pain.
"This is an impressive technique which had a profound positive effect on the patients in this pilot study," said Dr. Bennett. "It has the potential to be a long-term solution to intractable back pain due to joint disease."
Dr. Bennett and his colleagues are now developing a multi-center protocol to compare the results to patients who are treated with conventional pain therapy (including thermal radiofrequency) to the new minimally invasive facet arthrodesis.
Another study looked at the addition of spinal cord stimulation (SCS) to conventional medical management (CMM). Following a lumbosacral spinal surgery to alleviate pain, some patients continue to experience persistent or recurrent chronic pain -- also called Failed Back Surgery Syndrome (FBSS). They report persistent pain, disability, reduced health-related quality of life, and incur high Medicare costs.
To evaluate the addition of SCS to known surgical CMM, a trial of the effectiveness of SCS was conducted. One hundred patients suffering from FBSS from twelve centers in different parts of the world were randomized into two equal groups. One group received SCS, while the other received CMM.
At the end of six months, 48 percent of the SCS group experienced greater than 50 percent pain relief as compared to 9 percent in the CMM group (p<0.001).