A 50-year-old man with failed back surgery syndrome has persistent severe radicular right leg pain (greater than back pain) despite two lumbar discectomies, physiotherapy, gabapentin, and regular opioids. There are no significant psychological comorbidities. Which interventional option has the BEST evidence for long-term pain relief in this condition?
- A Spinal cord stimulation (dorsal column stimulation) ✓
- B Intrathecal morphine pump implantation
- C Repeated interlaminar epidural steroid injections
- D Repeat lumbar discectomy with fusion
Correct answer: A. Spinal cord stimulation (dorsal column stimulation)
Explanation
Spinal cord stimulation has the strongest evidence for failed back surgery syndrome with predominant radicular neuropathic pain. Randomized trials show superior pain relief compared to repeat surgery or conventional medical management. It modulates pain via gate control mechanisms. Intrathecal pumps are reserved for refractory cases after stimulation fails or is not available. Repeated epidural injections provide only temporary benefit.
Reference: Practical Management of Pain, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.