[Chronic epidural electrical stimulation of lumbar enlargement for pain relief after ineffective neurolysis in patients with post-traumatic sciatic neuropathy].

Abstract

Introduction: Peripheral nerveinjuries affect approximately 200.000 patients annually in Russia, and sciatic nerve injuries constitute about 8.3% (~16.600 cases). Many patients develop chronic neuropathic pain refractory to standard therapy. Surgical neurolysis provides adequate relief in only 50-80% of cases, and effective alternatives are needed for other patients. Chronic spinal cord stimulation (SCS) is a promising modality for these patients.

Objective: To evaluate efficacy and safety of chronic SCS for chronic pain due to post-traumatic sciatic neuropathy refractory to conservative therapy and neurolysis.

Material and methods: A retrospective single-center study included 10 patients with persistent neuropathic pain despite prior pharmacotherapy and neurolysis. All patients underwent SCS with pain assessment. The primary efficacy criterion was reduction of VAS score ≥50% after test stimulation period.

Results: Positive responses were achieved in 9 out of 10 patients (90%). Mean VAS scores significantly decreased from 7.9±1.3 to 3.3±1.5 (p=0.007). Therapeutic effect was maintained in all responders throughout the follow-up period (3 months-2 years) without complications.

Conclusion: Chronic SCS is a highly effective and safe treatment for chronic pain in patients with post-traumatic sciatic neuropathy resistant to standard therapies. These results justify SCS in such clinical scenarios and highlight the need for further prospective studies.