Spinal Cord Stimulation in Pregnant Patients: Current Perspectives of Indications, Complications, and Results in Pain Control: A Systematic Review

Overview

Journal Asian J Neurosurg

Specialty Neurology

Date 2019 May 31

PMID 31143246

Citations 1

Authors

Bruno Camporeze

Renata Simm

Marcos Vinicius Calfat Maldaun

Paulo Henrique Pires de Aguiar

Affiliations

Soon will be listed here.

Abstract

Spinal cord stimulation (SCS) has been described as a valuable neuromodulator procedure in the management of chronic medically untreated neuropathic pain. Although the use of this technique has been published in many papers, a question still remains regarding its applicability in pregnant patients. The goal of this paper is to discuss the risks, complications, and results as well as the prognosis of SCS in pregnant patients. We performed a systematic review from 1967 to 2018 using the databases MEDLINE, LILACS, SciELO, PubMed, and BIREME, utilizing language as selection criteria. Eighteen studies that met our criteria were found and tabulated. SCS is a reversible and adjustable surgical procedure, which results in patients that demonstrated a significant effect in the reduction of pain intensity in pregnant patients. The etiologies most frequent were complex regional pain and failed back pain syndromes, which together represented 94% of analyzed cases. The technical complications most frequent were lead migration (3%, = 1). Regarding the risks, the authors did not show significative factors among the categorical variables that can suggest a teratogenicity, while the maternal risks have been associated to the consequences of technical complications due to, among other factors, improvement of abdominal pressure during pregnancy and delivery. Finally, although there are not significative cohorts of pregnant patients, the procedure is still an effective surgical approach of neuropathic pain associated to lower rates of complications and significative improvement in the quality of life of patients during pregnancy.

Citing Articles

Successful spinal anaesthesia for caesarean section in a patient with a dorsal root ganglion stimulation implant: A case report.

van der Spek D, van der Marel C, de Vos C, Huygen F, Dirckx M Case Rep Womens Health. 2024; 44:e00652.

PMID: 39711604 PMC: 11662160. DOI: 10.1016/j.crwh.2024.e00652.

References

Brent R . Reproductive and teratologic effects of low-frequency electromagnetic fields: a review of in vivo and in vitro studies using animal models. Teratology. 1999; 59(4):261-86. DOI: 10.1002/(SICI)1096-9926(199904)59:4<261::AID-TERA12>3.0.CO;2-K. View

Lacroix I, Damase-Michel C, Lapeyre-Mestre M, Montastruc J . Prescription of drugs during pregnancy in France. Lancet. 2000; 356(9243):1735-6. DOI: 10.1016/s0140-6736(00)03209-8. View

Li D, Odouli R, Wi S, Janevic T, Golditch I, Bracken T . A population-based prospective cohort study of personal exposure to magnetic fields during pregnancy and the risk of miscarriage. Epidemiology. 2002; 13(1):9-20. DOI: 10.1097/00001648-200201000-00004. View

Huggon I, Ghi T, Cook A, Zosmer N, Allan L, Nicolaides K . Fetal cardiac abnormalities identified prior to 14 weeks' gestation. Ultrasound Obstet Gynecol. 2002; 20(1):22-9. DOI: 10.1046/j.1469-0705.2002.00733.x. View

Lo W, Friedman J . Teratogenicity of recently introduced medications in human pregnancy. Obstet Gynecol. 2002; 100(3):465-73. DOI: 10.1016/s0029-7844(02)02122-1. View

Kemler M, Furnee C . Economic evaluation of spinal cord stimulation for chronic reflex sympathetic dystrophy. Neurology. 2002; 59(8):1203-9. DOI: 10.1212/01.wnl.0000028686.74056.e3. View

Dworkin R, Backonja M, Rowbotham M, Allen R, Argoff C, Bennett G . Advances in neuropathic pain: diagnosis, mechanisms, and treatment recommendations. Arch Neurol. 2003; 60(11):1524-34. DOI: 10.1001/archneur.60.11.1524. View

Cameron T . Safety and efficacy of spinal cord stimulation for the treatment of chronic pain: a 20-year literature review. J Neurosurg. 2004; 100(3 Suppl Spine):254-67. DOI: 10.3171/spi.2004.100.3.0254. View

Turner J, Loeser J, Deyo R, Sanders S . Spinal cord stimulation for patients with failed back surgery syndrome or complex regional pain syndrome: a systematic review of effectiveness and complications. Pain. 2004; 108(1-2):137-47. DOI: 10.1016/j.pain.2003.12.016. View

10.

Andrade S, Gurwitz J, Davis R, Chan K, Finkelstein J, Fortman K . Prescription drug use in pregnancy. Am J Obstet Gynecol. 2004; 191(2):398-407. DOI: 10.1016/j.ajog.2004.04.025. View

11.

Franzini A, Ferroli P, Marras C, Broggi G . Huge epidural hematoma after surgery for spinal cord stimulation. Acta Neurochir (Wien). 2005; 147(5):565-7. DOI: 10.1007/s00701-004-0470-6. View

12.

Finnerup N, Otto M, McQuay H, Jensen T, Sindrup S . Algorithm for neuropathic pain treatment: an evidence based proposal. Pain. 2005; 118(3):289-305. DOI: 10.1016/j.pain.2005.08.013. View

13.

Taylor R, Van Buyten J, Buchser E . Spinal cord stimulation for complex regional pain syndrome: a systematic review of the clinical and cost-effectiveness literature and assessment of prognostic factors. Eur J Pain. 2005; 10(2):91-101. DOI: 10.1016/j.ejpain.2005.02.004. View

14.

HANSON J, Goodman E . Labor epidural placement in a woman with a cervical spinal cord stimulator. Int J Obstet Anesth. 2006; 15(3):246-9. DOI: 10.1016/j.ijoa.2005.08.007. View

15.

Torrance N, Smith B, Bennett M, Lee A . The epidemiology of chronic pain of predominantly neuropathic origin. Results from a general population survey. J Pain. 2006; 7(4):281-9. DOI: 10.1016/j.jpain.2005.11.008. View

16.

Attal N, Cruccu G, Haanpaa M, Hansson P, Jensen T, Nurmikko T . EFNS guidelines on pharmacological treatment of neuropathic pain. Eur J Neurol. 2006; 13(11):1153-69. DOI: 10.1111/j.1468-1331.2006.01511.x. View

17.

Pennick V, Young G . Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database Syst Rev. 2007; (2):CD001139. DOI: 10.1002/14651858.CD001139.pub2. View

18.

Kumar K, Taylor R, Jacques L, Eldabe S, Meglio M, Molet J . Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomised controlled trial in patients with failed back surgery syndrome. Pain. 2007; 132(1-2):179-88. DOI: 10.1016/j.pain.2007.07.028. View

19.

Schwarz E, Postlethwaite D, Hung Y, Armstrong M . Documentation of contraception and pregnancy when prescribing potentially teratogenic medications for reproductive-age women. Ann Intern Med. 2007; 147(6):370-6. PMC: 2941151. DOI: 10.7326/0003-4819-147-6-200709180-00006. View

20.

Bouhassira D, Lanteri-Minet M, Attal N, Laurent B, Touboul C . Prevalence of chronic pain with neuropathic characteristics in the general population. Pain. 2007; 136(3):380-387. DOI: 10.1016/j.pain.2007.08.013. View