Passive recharge burst spinal cord stimulation for the treatment of refractory nonsurgical low back pain: 24-month results from a prospective randomized controlled trial and predictors of success.

Authors

James J Yue, Steven Falowski, Edward Tavel, Robert Heros, Anne Christopher, Denis Patterson, Robert Funk, Ibrahim Mohab, Sayed Wahezi, Jacqueline Weisbein, Christopher J Gilligan, Ajay Antony, Michael Fishell, Jessica Jameson, Chi Lim, Nathan Miller, Derron Wilson, Patrick Buchanan, David Dickerson, Keith Scarfo, Robert Levy, Mehul J Desai, Edward Braun, Susan Moeschler, Julie Pilitsis, Scott Kreiner, Jijun Xu, Jonathan Duncan, Kenneth Candido, Michael J Dorsi, Rafe Sales, Todd Lansford, Martin E Weinand, Nrupen Baxi, Jason Garber, James Forage, Albert E Telfeian, Haddad Souheil, Bram Blomme, Natalie Brill, Gayle Johnson, Timothy Deer

Published in

North American Spine Society journal. Volume 27. Pages 100911. Epub Jun 08, 2026.

Abstract

Spinal cord stimulation (SCS) is an established treatment for chronic pain, but long-term results are limited. The objective of this manuscript was to evaluate the 24-month durability of outcomes for patients with nonsurgical refractory chronic low back pain (NS-CLBP) treated with implanted burst SCS, including common diagnoses of NS-CLBP, and predictors of SCS success.
The DISTINCT study was a prospective, multicenter, randomized, controlled trial that investigated the use of SCS for NS-CLBP compared to conventional medical treatment alone. Efficacy and safety data were collected after the optional crossover at 6 months. Univariable and multivariable regression analyses were performed for predictor analyses at 24 months. Dependent variables were pain intensity (NRS), back pain-related disability (ODI), and pain catastrophizing (PCS). Independent variables were selected baseline characteristics, including the PainDetect questionnaire to assess pain as neuropathic (vs. mechanical/nociceptive).
NRS responder rates (≥50% reduction) at 24 months for SCS and crossover patients were of 77% and 79%, respectively. Secondary outcomes indicated significant sustained improvements in ODI, PCS, and reduced healthcare utilization. Six serious adverse events were reported and resolved without sequelae. Improvements on the NRS, ODI, and PCS for common subetiologies mirrored those of the overall NS-CLBP group. After adjusting for covariates, higher baseline PCS scores and leg pain were predictors of super-responders, or patients who responded to all 3 scales. Patients with predominantly neuropathic pain reported more robust 24-month ODI and PCS outcomes than patients with mechanical/nociceptive pain. Patients reported similar NRS improvements regardless of pain type.
Implanted passive recharge burst SCS provides a significant and sustained therapeutic effect 2 years after implantation in patients with NS-CLBP. Even patients with the highest symptom burden report success at 24 months. Although neuropathic pain increases the magnitude of burst SCS success in NS-CLBP, particularly regarding disability and catastrophizing, patients with nociceptive pain also obtain substantial benefit.

PMID:
42434718
Bibliographic data and abstract were imported from PubMed on 11 Jul 2026.

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