Sindrome postlaminectomía lumbar II. Tratamiento del dolor mediante técnicas de neuromodulación

The application of neuro-modulation techniques in general is currently gaining acceptance in various aspects of medicine. Neuro-modulation is defined as: “Terapeutical interventions using implantable devices to modify the functioning of central, peripheral and and autonomic nervosus sysmtems”. Following lumbar disc surgery, or lumbar spine surgery in general, several chronic pain syndromes can result, either in the lumbar region and/or in the lower limbs. The current status is for the application of surgery to the degenerative spine (degenerative disc disease and lumbar stenosis) for the relief of chronic pain. A review of the methodology of evidence based medicine, show that the instrumented and fusion techniques are not the answerd despite 20 years of the use of these techniques following failure of surgery for the relief of back pain syndrome. Neuromodulation techniques represent a step in the right direction for the management of these chronic pain syndromes. Frecuently they enable the resolution of chronic pain following spine surgery without having to resort to repeat surgery. We describe here the different neuro-modulation techniques (spinal cord stimulation, spinal drug infusions) which can be used in the case of back surgery failure, and we describe technical aspects and “tricks of the trade” for the correct implantation of the devices used in techniques. Neuro-modulation techniques are applied to the management of chronic pain following disc surgery and represent a valid alternative to repeat surgery and/or arthrodesis (instrumented or not). Neurosurgeosn are again called to play active roles in the field of neuro-modulation for the treatment of pain as well as in the field of neuro-modulation of abnormal movements disorders, for psychosurgery and the revovery of neurological functions.