'Hybrid neurostimulator': simultaneous use of spinal cord and peripheral nerve field stimulation to treat low back and leg pain.

Treatment of chronic back and leg pain in patients with failed back surgery syndrome (FBSS) remains problematic as none of the currently available approaches are universally successful in achieving lasting pain control. Spinal cord stimulation (SCS) is very effective for controlling radicular pain but rarely provides adequate control of pain in the lower back. Recently, a technique of peripheral nerve stimulation (PNS) was introduced to control pain in a group of patients for whom back pain dominated the clinical picture. Because PNS does not control neuropathic pain due to lumbosacral radiculopathy involving the lower extremities, we developed a hybrid technique of SCS and PNS that offers potential control of both axial pain in the lumbar area and radicular pain to the lower extremities. This chapter presents our results and the possible mechanisms of action.