Disease modifying therapies: Restorative neurostimulation for chronic low back pain

Chronic low back pain is multifactorial in nature, and recently there has been expanded attention to multifidus dysfunction and altered sensorimotor control. Persistent altered sensorimotor control might manifest as impaired multifidus activation secondary to arthrogenic muscle inhibition. Over time, this may lead to a repetitive cycle of multifidus inhibition, atrophy, altered spinal biomechanics, and potentially functional spinal instability and chronic pain. Restorative neurostimulation of the lumbar medial branch nerve is a novel treatment for refractory chronic mechanical low back pain in patients with diagnostic evidence of multifidus muscle dysfunction. Restorative neurostimulation distinguishes itself from palliative or symptomatic therapies such as ablative therapies, spinal cord stimulation (SCS) and temporary peripheral nerve stimulation (PNS) and it targets a different etiology of low back pain. This therapy stimulates motor nerves and has a restorative neurostimulating mechanism of action that secondarily reduces pain and disability through a progressive and gradual rehabilitative fashion of cycled multifidus contraction that may normalize multifidus activity incrementally and thereby restore functional spinal stability.