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To determine the effectiveness of spinal cord stimulation (SCS) as a therapeutic option for various neuropathic pain syndromes in children, a systematic review, single-institution series, and individual participant data meta-analysis was conducted.
In pediatrics with chronic neuropathic pain, spinal cord stimulation effectively reduces pain and medication use, and improves functional status.
To determine the effectiveness of spinal cord stimulation (SCS) as a therapeutic option for various neuropathic pain syndromes in children, a systematic review, single-institution series, and individual participant data meta-analysis was conducted.
Results for pediatric patients (≤ 19 years of age) who had been referred by the multidisciplinary pain clinic for assessment for SCS and had persistent neuropathic pain syndromes were compiled. Using Scopus, EMBASE, and PubMed, a systematic review and individual participant data (IPD) meta-analysis were carried out to describe the results of children treated with SCS for neuropathic pain.
Nine individuals out of twelve who underwent evaluation were recommended for buried or percutaneous lead trials. Trial leads were implanted in seven female and two male patients between the ages of 13 and 19. Overall, 89% (8 out of 9) of patients received permanent systems. The length of stay for both the implant and trial was shorter than one day, with an average trial duration of six days.
For the implant and trial, the CSF leak-related complication rates were 0% and 22%, respectively. The number of drugs reduced from 4.9 to 2.1, and the pain ratings on the visual analogue scale (VAS) dropped from 9.2 to 2.9. Each patient's functional condition, including improved matriculation, gainful employment, and physical activity also improved. A total of 13 articles documenting pediatric SCS subjects were found in a systematic review, 12 of which provided IPD on 30 subjects.
Pain was decreased in 96.2% (25/26) of the patients at the last follow-up and in 100% (16/16) of the patients after surgery in the IPD meta-analysis. In 76.2% (16/21), medication usage was reduced, and in 29/29 (100%), functional results were enhanced. Notably, 16.7% (5/30) was the complication rate.
SCS appears to be beneficial for treating a range of persistent, medically unresponsive neuropathic pain disorders in children.
Neurosurgical Focus
Spinal cord stimulation for treatment of chronic neuropathic pain in adolescent patients: a single-institution series, systematic review, and individual participant data meta-analysis
Salma M Bakr et al.
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