Retrospective Review of 60-day PNS Targeting Lumbar Medial Branches in Individuals with Back Pain from Spondylosis Without Radiculopathy- MHSRS 2024

cohen s, li s, lester d, clark w, mcgee m, boggs j

Abstract accepted for oral presentation at the 2024 Military Health System Research Symposium

Chronic low back pain (CLBP), including degenerative spine conditions such as spondylosis, is associated with debilitating pain and functional impairments and is a significant problem for US Service Members and Veterans. Percutaneous (60-day) peripheral nerve stimulation (PNS) is an opioid-free, non-destructive treatment that is commercially available, in use in the Military Health System, and has resulted in meaningful pain relief and functional improvement across various conditions. A large prospective multicenter trial previously presented at MHSRS revealed significant and sustained long-term relief of CLBP. The present analysis explores real-world outcomes for patients with a diagnosis of spondylosis, including a subset with reported ICD10 codes M47.816/M47.817 (lumbar/lumbosacral spondylosis without myelopathy or radiculopathy), to determine if real-world outcomes are consistent with the prospective study.

Data were retrospectively reviewed from a real-world database of patients who: previously received 60-day PNS targeting the lumbar medial branch nerve(s), were reported as having lumbar spondylosis without neuropathic symptoms, opted to provide anonymized data, and provided baseline and end of treatment (EOT) outcomes. A subset was analyzed in those with confirmed ICD-10 diagnosis codes M47.816 or M47.817. Responders were defined as patients who reported ≥50% pain relief and/or clinically meaningful improvement (≥1) in physical function as measured by the Patient Global Impression of Change. Safety was not analyzed in this retrospective review

Consistent with prospective trials, PNS targeting the lumbar medial branches produced significant improvements in real world outcomes of pain and physical function at EOT in the majority of patients with spondylosis. A follow-on DoD PRMRP-funded randomized controlled trial (the RESET Study) that compares 60- day PNS to standard interventional management for CLBP recently completed enrollment and primary endpoint results are expected in 2025. 60-day percutaneous PNS treatment is an opioid-free, non-destructive treatment option available for U.S. Service Members and Veterans with spondylosis without myelopathy or radiculopathy.