Introduction: Spinal cord stimulation (SCS) is effective for chronic refractory pain, yet the impact of spinal anatomical factors on treatment outcomes remains unclear. This study examines the relationship between specific spinal canal parameters and SCS outcomes, including pain relief and surgery duration.
Methods: A retrospective cohort of 56 patients (mean age 65 ± 12 years) who received SCS for refractory pain from 2016 to 2024 was analyzed. Successful pain relief was defined as ≥50% pain reduction at 1-year post-surgery. Anatomical measurements, including the posterior thecal sac to dorsal canal wall distance and free canal space at the T8 and T9-T10 levels, were collected. Patients were also stratified by surgery duration into long (≥84 min) and short (≤84 min) groups, with comparisons made across pain outcomes and surgery duration.
Results: Thirty-eight patients with pain relief were compared to 18 patients with no relief after 1 year of SCS therapy. Pain relief was associated with a shorter T8 posterior thecal sac to dorsal canal wall distance (6.50 mm vs. 8.01 mm, p = 0.04). Successfully treated patients showed a trend toward smaller free canal space at T8 (49% vs. 68%, p = 0.29) and T9-T10 (48% vs. 67%, p = 0.35). A larger dorsal canal space triangle area at T9-T10 was observed in patients with shorter surgery durations (31.91 mm² vs. 23.96 mm², p = 0.071). No significant differences in age, gender, BMI, or underlying pain diagnosis were noted between groups.
Conclusion : These findings suggest that certain anatomical parameters, notably the posterior thecal sac to dorsal canal wall distance, may influence SCS outcomes. Tighter dorsal canal space could potentially enhance electrode contact with the dorsal columns, though it may increase surgical complexity and duration. Further research is needed to clarify these anatomical predictors of SCS efficacy.
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