Medical Student Case Western Reserve University School of Medicine
Disclosure(s):
Crystal Xu, BS: No financial relationships to disclose
Introduction: Lower back pain is one of the leading causes of disability in the world. One effective treatment for chronic back and leg pain is Spinal Cord Stimulation (SCS), but the prevalence of spinal deformity within this population undergoing SCS has not been well delineated. The aim of this study was to define the spinopelvic parameters for those undergoing SCS at our institution and evaluate the association between worsening deformity and response to SCS
Methods: A retrospective review was conducted for patients who underwent SCS implantation at our institution from 2003 to 2023. Inclusion criteria were patients with preoperative and postoperative x-rays, pain in the lower back, and a diagnosis of axial back pain, post-laminectomy syndrome, or failed back surgery syndrome. Patients with cervical stimulation or complex regional pain syndrome were excluded. Radiographic measurements included sacral slope, pelvic incidence, pelvic tilt, lumbar lordosis, segmental lordosis, pelvic obliquity, presence of spondylolisthesis, and largest lumbosacral coronal cobb angle. Postoperative outcomes up to two years were collected.
Results: A total of 80 patients met the inclusion criteria. Mean degrees were found as follows: pelvic incidence 58.52 (SD=13.13), pelvic tilt 22.31 (SD=9.65), sacral slope 36.30 (SD=10.06), lumbar lordosis 47.12 (SD=16.03), segmental lordosis 30.35 (SD=10.92), pelvic obliquity 1.23 (SD=1.84), largest lumbar coronal cobb 6.31 (SD=7.20), and the difference in pelvic incidence and lumbar lordosis 22.31 (SD=9.65). Thirty nine (48%) of the patients were found to have a lumbar spondylolisthesis. Of the 29 patients with follow-up greater than 6 months, those patients with successful response to therapy (greater than 50% reduction in preoperative pain) had a higher mean coronal cobb (8.48 vs 5.69), lumbar lordosis (53.08 vs 44.60), pelvic tilt (24.56 vs 21.85), sacral slope (41.20 vs 35.55), and pelvic incidence (65.24 vs 57.45). Spondylolisthesis was also more common in the responders (71% vs 55%).
Conclusion : Preliminary analysis of our data suggests that many of the patients undergoing spinal cord stimulation have abnormal spinopelvic parameters suggesting some degree of lumbosacral deformity. Further analysis of the spinopelvic parameters in our population as well as the relationship between these preoperative parameters and response to therapy is warranted