Severity of spinal degeneration does not affect the pain reduction under continuous epidural analgesia

Vincent J. Heck, Bastian Himpe, Juan M. Vinas-Rios, Tobias Prasse, Michael J. Pflüger, Maximilian Lenz, Sven Schmidt, Paul Kessler, Michael Rauschmann

October 2023, Volume 32, Issue 10, pp 3370- 3378 Original Article Read Full Article

First Online: 16 August 2023

Purpose

To outline clinical effectiveness of continuous epidural analgesia (CEA) in patients with failed back surgery syndrome (FBSS) or lumbar spinal stenosis (LSS) depending on severity of spinal degeneration.

Methods

In this retrospective cohort study, all patients with FBSS or LSS who underwent CEA within an inpatient rehabilitation program were evaluated. The pain reduction was measured by VAS on an hourly basis. Substantial pain reduction was defined as a minimal clinically important difference (MCID) > 50%. Severity of spinal degeneration, side effects and patient-specific characteristics were documented.

Result

We included a total of 148 patients with 105 patients suffering from FBSS and 48 with LSS. The average pain reduction was − 37.6 ± 19.2 in FBSS and − 38.1 ± 17.8 in LSS group (p < .001 and p < .001, respectively). In the FBSS group, sensory deficits (p = .047) and numbness (p = .002), and in the LSS group, a severe disability measured by ODI (38.2 ± 15.4 vs. 57.3 ± 11.3, p < .001) significantly contributed to a worse outcome. The severity of the spinal degeneration and psychological disorders did not affect the pain reduction in terms of MCID.

Conclusions

This study provides new evidence about CEA in the treatment of FBSS and LSS. CEA provides a significant pain reduction even under intensified physiotherapeutic exercising in patients with severe spinal degeneration and a broad variety of secondary diagnoses. Neurologic deficits in case of FBSS and severe disability in case of LSS may be risk factors for less favorable outcome.

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