Intraoperative Spinal Cord Stimulation Mitigates Central Sensitization after Spine Surgery in Mice.

STUDY DESIGN: Double-blinded, prospective laboratory animal study.

OBJECTIVE: To examine if intraoperative spinal cord stimulation (SCS) inhibits the development of spine surgery-induced hypersensitivity.

SUMMARY OF BACKGROUND DATA: Managing postoperative pain after spine surgery is challenging, and as many as 40% of patients may develop failed back surgery syndrome (FBSS). While SCS has been shown to effectively reduce chronic pain symptoms, it is unknown if intraoperative SCS can mitigate the development of central sensitization that potentially leads to FBSS after spine surgery.

METHODS: Mice were randomly stratified into three experimental groups:1) sham surgery; 2) laminectomy alone; 3) laminectomy plus SCS. Secondary mechanical hypersensitivity was measured in hind paws using von Frey assay one day before and at predetermined times after surgery. In addition, we also performed a conflict avoidance test to capture the affective-motivational domain of pain at selected time points post-laminectomy.

RESULTS: Mice that underwent unilateral T13 laminectomy developed mechanical hypersensitivity in both hind paws. Intraoperative SCS applied to the exposed side of the dorsal spinal cord significantly inhibited the development of hind paw mechanical hypersensitivity on the SCS-applied side. Sham surgery did not produce any obvious secondary mechanical hypersensitivity in the hind paws.

CONCLUSION: These results demonstrate that spine surgery for unilateral laminectomy induces central sensitization that results in postoperative pain hypersensitivity. Intraoperative SCS after laminectomy may be able to mitigate the development of this hypersensitivity in appropriately selected cases.