Research Article
Spinal Cord Stimulation in Failed Back
Surgery Syndrome: Effects on Posture and Gait—A Preliminary
3D Biomechanical Study
L. Brugliera,
1
A. De Luca,
2
S. Corna,
1
M. Bertolotto,
3
G. A. Checchia,
4
M. Cioni,
5
P. Capodaglio,
1
and C. Lentino
2,4
1
Istituto Auxologico Italiano, Unit` a di Riabilitazione Osteoarticolare, Ospedale S Giuseppe, Strada Cadorna 90, Piancavallo, Italy
2
Laboratorio Analisi del Movimento Ospedale Santa Corona di Pietra Ligure, Viale 25 Aprile 38, 17027 Pietra Ligure, Italy
3
Centro Terapia del Dolore e Cure Palliative, Dipartimento di Riabilitazione, Ospedale Santa Corona di Pietra Ligure,
Viale 25 Aprile 38, 17027 Pietra Ligure, Italy
4
Struttura Complessa Recupero e Rieducazione Funzionale, Ospedale Santa Corona di Pietra Ligure, Viale 25 Aprile 38,
17027 Pietra Ligure, Italy
5
Scuola di Specializzazione in Medicina Fisica e Riabilitativa, Dipartimento di Scienze Biomediche e Biotecnologiche,
Universit` a degli Studi di Catania, Piazza Universit` a 2, 95131 Catania, Italy
Correspondence should be addressed to P. Capodaglio; p.capodaglio@auxologico.it
Received 30 March 2017; Revised 21 June 2017; Accepted 1 August 2017; Published 25 September 2017
Academic Editor: Emily J. Bartley
Copyright © 2017 L. Brugliera et al. Tis is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
We studied 8 patients with spinal cord stimulation (SCS) devices which had been previously implanted to treat neuropathic chronic
pain secondary to Failed Back Surgery Syndrome. Te aim of our study was to investigate the efects of SCS on posture and gait
by means of clinical scales (Short Form Health Survey-36, Visual Analogue Scale for pain, and Hamilton Depression Rating Scale)
and instrumented evaluation with 3D Gait Analysis using a stereophotogrammetric system. Te latter was performed with the
SCS device turned both OFF and ON. We recorded gait and posture using the Davis protocol and also trunk movement during
fexion-extension on the sagittal plane, lateral bending on the frontal plane, and rotation on the transversal plane. During and 30
minutes afer the stimulation, not only the clinical scales but also spatial-temporal gait parameters and trunk movements improved
signifcantly. Improvement was not shown under stimulation-OFF conditions. Our preliminary data suggest that SCS has the
potential to improve posture and gait and to provide a window of pain-free opportunity to optimize rehabilitation interventions.
1. Introduction
Chronic pain of moderate to severe intensity occurs in 19%
of adult Europeans, seriously afecting the quality of their
social and working lives [1, 2]. Te prevalence of neuropathic
chronic pain is estimated within 0.9 and 8% [3, 4]. Chronic
pain has direct consequence on the quality of daily living
and also a considerable social cost either for the national
health services or for the employers [2, 5]. Failed Back Surgery
Syndrome (FBSS) has been defned as “persistent or recurrent
pain in the back/neck or limbs despite surgery or treatment
thought likely to relieve pain.” Afer determining the cause
of FBSS, a multidisciplinary approach is preferred, including
pharmacologic management of pain, physical therapy, and
behavioural intervention, as well as therapeutic procedures
such as injections, radiofrequency ablation, lysis of adhesions,
spinal cord stimulation, and surgical revisions. Physical ther-
apy and medication management are the cornerstone of frst-
line management of FBSS. When this combined approach is
not efective, neuromodulation therapies, in particular spinal
cord stimulation (SCS), have to be considered. Spinal cord
stimulation has been established as a cost-efective treatment
for patients with neuropathic back and leg pain [6, 7]. Te
PROCESS study in 2007 involved 100 patients with FBSS
and looked at the efects of adding SCS to usual care in
comparison with usual care alone. Te study demonstrated
Hindawi
Pain Research and Management
Volume 2017, Article ID 3059891, 9 pages
https://doi.org/10.1155/2017/3059891