Comparison of Clinical Efficacy and Computed Tomographic Analysis of Lead Position Between Three-Column and Five-Column Paddle Leads Spinal Cord Stimulation for Failed Back Surgery Syndrome.

OBJECTIVE: To investigate the difference in clinical outcome and the position of paddle lead spinal cord stimulation (SCS) between 3-column and 5-column paddle lead SCS in patients with failed back surgery syndrome.

METHODS: In 21 patients who underwent paddle lead SCS at T9 (3-column, n = 9; 5-column, n =12) for failed back surgery syndrome, a 12-month follow-up numerical rating scale, percent pain relief, and computed tomography assessment of contact angle and percent reduction of T9 canal area were investigated.

RESULTS: There was no difference in paresthesia coverage of the painful area, trial success rate, clinical outcomes, and percent pain relief between the 2 groups (P >0.05). The contact angle in the 5-column group was generally more than that of the 3-column group (P = 0.067). Overall reduction of 35.51% ± 4.76% in the T9 canal was observed and there was no difference between the 2 groups (P >0.05) and no correlation between the contact angle and percent T9 spinal canal reduction (r = -0.247, P > 0.05).

CONCLUSIONS: Although clinical efficacy of SCS using three-column and five-column paddle lead was not significant different from each other, significant inclination of paddle lead in posterior epidural space with significant reduction in T9 canal area were observed in both groups. The degree of inclination in the 5-column group was more than that in the 3-column lead group. Close approximation of paddle lead contacts to dorsal spinal cord with reduced dorsal cerebrospinal fluid space and intraoperative neurophysiologic guidance might have contributed to the high rate of trial success and long-term pain control.