Long-Term Outcomes of Restorative Neurostimulation in Patients With Refractory Chronic Low Back Pain Secondary to Multifidus Dysfunction: Two-Year Results of the ReActiv8-B Pivotal Trial.

Journal Article (Journal Article)

BACKGROUND: Impaired neuromuscular control and degeneration of the multifidus muscle have been linked to the development of refractory chronic low back pain (CLBP). An implantable restorative-neurostimulator system can override the underlying multifidus inhibition by eliciting episodic, isolated contractions. The ReActiv8-B randomized, active-sham-controlled trial provided effectiveness and safety evidence for this system, and all participants received therapeutic stimulation from four months onward. OBJECTIVE: This study aimed to evaluate the two-year effectiveness of this restorative neurostimulator in patients with disabling CLBP secondary to multifidus muscle dysfunction and no indications for spine surgery. MATERIALS AND METHODS: Open-label follow-up of 204 participants implanted with a restorative neurostimulation system (ReActiv8, Mainstay Medical, Dublin, Ireland) was performed. Pain intensity (visual analog scale [VAS]), disability (Oswestry disability index [ODI]), quality-of-life (EQ-5D-5L), and opioid intake were assessed at baseline, six months, one year, and two years after activation. RESULTS: At two years (n = 156), the proportion of participants with ≥50% CLBP relief was 71%, and 65% reported CLBP resolution (VAS ≤ 2.5 cm); 61% had a reduction in ODI of ≥20 points, 76% had improvements of ≥50% in VAS and/or ≥20 points in ODI, and 56% had these substantial improvements in both VAS and ODI. A total of 87% of participants had continued device use during the second year for a median of 43% of the maximum duration, and 60% (34 of 57) had voluntarily discontinued (39%) or reduced (21%) opioid intake. CONCLUSIONS: At two years, 76% of participants experienced substantial, clinically meaningful improvements in pain, disability, or both. These results provide evidence of long-term effectiveness and durability of restorative neurostimulation in patients with disabling CLBP, secondary to multifidus muscle dysfunction. CLINICAL TRIAL REGISTRATION: The study is registered on clinicaltrials.gov with identifier NCT02577354.

Full Text

Duke Authors

Cited Authors

  • Gilligan, C; Volschenk, W; Russo, M; Green, M; Gilmore, C; Mehta, V; Deckers, K; De Smedt, K; Latif, U; Georgius, P; Gentile, J; Mitchell, B; Langhorst, M; Huygen, F; Baranidharan, G; Patel, V; Mironer, E; Ross, E; Carayannopoulos, A; Hayek, S; Gulve, A; Van Buyten, J-P; Tohmeh, A; Fischgrund, J; Lad, S; Ahadian, F; Deer, T; Klemme, W; Rauck, R; Rathmell, J; Maislin, G; Heemels, JP; Eldabe, S; ReActiv8-B Investigators,

Published Date

  • January 2023

Published In

Volume / Issue

  • 26 / 1

Start / End Page

  • 87 - 97

PubMed ID

  • 35088722

Electronic International Standard Serial Number (EISSN)

  • 1525-1403

Digital Object Identifier (DOI)

  • 10.1016/j.neurom.2021.10.011


  • eng

Conference Location

  • United States