Spinal Cord Stimulation for Neurogenic Claudication Associated with Lumbar Spinal Stenosis

Background: There is a debate on the long-term outcomes of surgical decompression for lumbar spinal stenosis (LSS) as compared to conservative treatment, with even more limited outcomes in repeat surgeries. Hence, other less invasive treatment modalities, such as neuromodulation with a modern spinal cord stimulator (SCS), could be considered in the spectrum of management options for symptoms of neurogenic claudication (NC) related to LSS as an alternative to surgery. Objective: Assessing the outcomes and efficacy of SCS in neurogenic claudication in patients with or without a prior lumbar surgery. Study Design: This is a retrospective study of a prospectively collected database. Setting: The research was conducted at the Medical College of Wisconsin (MCW), an academic medical center, in Milwaukee, Wisconsin. Methods: This study reviewed all patients who had undergone SCS therapy for symptoms consistent with NC between 2013 through 2020. The data were collected from MCW. Only patients with at least one year of follow-up were included in outcome assessment. Results: One hundred and eighteen patients with primary symptoms of NC underwent an SCS trial with an 86% pass-rate. A total of 69 of the 93 patients who underwent permanent SCS implantation had at least one year of follow-up. All patients reported initial improvement after permanent implantation. At one-year follow-up, 55 (80%) patients had sustained improvement of their pain levels and claudication symptoms, of whom 52 (75%) continued to experience benefit for an average of at least 27 months. For patients with no prior surgical decompression, 86% continued to experience sustained benefit at the latest follow-up. Limitations: This study has several limitations. It is of a retrospective nature that includes selection and recall biases. It is a single-center study that limits its generalizability. More limitations are discussed in the main article. Conclusions: With modern SCS techniques, the majority of patients can achieve sustained improvement of symptoms of NC of at least a 2-year duration regardless of previous history of lumbar decompressive surgery. SCS can be considered as part of the conservative treatment options before committing to surgical decompression.