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. 2022 Apr;164(4):1187-1191.
doi: 10.1007/s00701-021-05107-4. Epub 2022 Jan 5.

Combination of waveforms in modern spinal cord stimulation

Piedade G S  1 , Gillner S  2 , Slotty P J  2 , Vesper J  2
Affiliations

Combination of waveforms in modern spinal cord stimulation

Piedade G S et al. Acta Neurochir (Wien). 2022 Apr.

Abstract

Background: After the surge of burst stimulation, different waveforms were developed to optimize results in spinal cord stimulation. Studies have shown higher responder rates for multiwave therapy, but since the launch of such multiwave systems, little is known about the patients' preference regarding waveforms in the long-term follow-up. No study connected particular waveforms to specific pain etiologies or required stimulation parameters so far.

Method: Thirty-four patients with refractory chronic neuropathic pain were treated with spinal cord stimulation systems providing multiwave therapy between September 2018 and October 2019. Patients with a follow-up of at least 6 months were selected; 10 subjects were excluded due to revision surgery, infection, and loss to follow-up. Data regarding pain intensity and preferred waveform for the trial, the implantation, 3-month and 6-month follow-up were recorded.

Results: During the trial phase, 10 patients (43.5%) achieved significant pain relief using tonic stimulation, 5 using burst (21.7%), 3 using microburst (13.0%), and 4 using a combination of tonic and microburst (17.4%). One single patient preferred Contour stimulation during the trial. After 3 months, 6 patients preferred microburst (25%), 6 preferred tonic (25%), 5 used a combination of tonic and microburst (20.8%), and 5 patients used burst (20.8%). After 6 months, similar results were obtained. Contour and Whisper were used in complex cases failing to other waveforms.

Conclusions: Tonic stimulation, isolated or in combination, remains an important component in spinal cord stimulation, being used by almost half of the patients. Over time, the usage of microburst increased considerably. Whisper and Contour, although battery-consuming, are good salvage options in complex cases.

Keywords: Combination therapy; Neuropathic pain; Spinal cord stimulation; Waveform.

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Conflict of interest statement

PJS and JV received travel expense reimbursement and speaker honoraria from Abbott. JV is paid consultant of Abbott. GSP certifies that he has no affiliations with or involvement in any organization or entity with any financial or non-financial interest in the subject matter or materials discussed in this manuscript.

References

    1. Billot M, Naiditch N, Brandet C, et al. Comparison of conventional, burst and high-frequency spinal cord stimulation on pain relief in refractory failed back surgery syndrome patients: study protocol for a prospective randomized double-blinded cross-over trial (MULTIWAVE study) Trials. 2020;21(1):696. doi: 10.1186/s13063-020-04587-6. - DOI - PMC - PubMed
    1. Courtney P, Espinet A, Mitchell B, Russo M, Muir A, Verrills P, Davis K. Improved pain relief with burst spinal cord stimulation for two weeks in patients using tonic stimulation: results from a small clinical study. Neuromodulation. 2015;18(5):361–366. doi: 10.1111/ner.12294. - DOI - PMC - PubMed
    1. De Ridder D, Vanneste S, Plazier M, van der Loo E, Menovsky T. Burst spinal cord stimulationtoward paresthesia-free pain suppression. Neurosurgery. 2010;66(5):986–990. doi: 10.1227/01.NEU.0000368153.44883.B3. - DOI - PubMed
    1. Haider N, Ligham D, Quave B, et al. Spinal cord stimulation (SCS) trial outcomes after conversion to a multiple waveform SCS system. Neuromodulation. 2018;21(5):504–507. doi: 10.1111/ner.12783. - DOI - PubMed
    1. Kapural L, Yu C, Doust MW, et al. Novel 10-kHz high-frequency therapy (HF10 therapy) is superior to traditional low-frequency spinal cord stimulation for the treatment of chronic back and leg pain: the SENZA-RCT randomized controlled trial. Anesthesiology. 2015;123(4):851–860. doi: 10.1097/ALN.0000000000000774. - DOI - PubMed

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