Successful Treatment of Chronic Back and Leg Pain With Lower Than Usual Placement of High-Frequency Spinal Cord Stimulation in a Patient With Uncorrected Tethered Cord: Case Report

ABSTRACT BACKGROUND AND IMPORTANCE Tethered cord syndrome (TCS) often leads to severe back and leg pain. The typical treatment to stall disease progression is untethering surgery, but this is not always effective for pain. Spinal cord stimulation (SCS) is an efficacious treatment for neuropathic pain. However, it has seldom been utilized in TCS cases. Moreover, with cord elongation, ideal paddle placement is not certain. CLINICAL PRESENTATION We present the case of a 77-yr-old male with severe chronic lower-back and lower-extremity pain. Magnetic resonance imaging (MRI) showed severe lumbar spine degenerative changes, along with a previously undiagnosed spina bifida and conus medullaris termination at L5. We felt that SCS would be the best treatment avenue for his chief complaint of pain. Due to cord elongation, we trialed lower placement of the high-frequency (HF)-SCS system at T11-T12, which led to 80% improvement in pain symptoms within 1 wk and ability to walk for the first time in a year. At his first follow-up appointment, the patient endorsed 80% to 90% relief of his lower-back and bilateral lower-extremity pain, which improved to 100% relief at 12 mo at last visit. CONCLUSION Only 4 other reports were identified in the literature utilizing SCS in TCS cases. Our case adds to the limited body of literature that SCS is an effective therapy for pain in TCS and degenerative spine disease. Only 2 other reports employed lower than usual lead placement. Our case demonstrates that lead placement may need to be changed to accommodate the elongated cord.

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Multicolumn Spinal Cord Stimulation Lead Implantation Using an Optic Transligamentar Minimally Invasive Technique

Neurosurgery ◽

10.1227/neu.0000000000000008 ◽

2013 ◽

Vol 73 (3) ◽

pp. 550-553 ◽

Cited By ~ 16

Author(s):

Philippe Rigoard ◽

Anh Tran Luong ◽

Alexandre Delmotte ◽

Mille Raaholt ◽

Manuel Roulaud ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Stimulation ◽

Failed Back Surgery Syndrome ◽

Leg Pain ◽

Invasive Technique ◽

Lower Back ◽

Lead Placement ◽

Failed Back Surgery ◽

Back Surgery ◽

New Generation

Abstract BACKGROUND: A new generation of neurostimulation surgical leads is used to increase the success of spinal cord stimulation in difficult-to-treat indications such as failed back surgery syndrome. Minimal access spinal technologies (MASTs) have previously been used for surgical lead implantation. However, only a unilateral approach was possible, causing difficulties for median lead placement, and not always preventing laminectomy. A recent MAST technique was used to implant spinal cord stimulation leads without these limitations. OBJECTIVE: To describe the MAST technique used in a pilot study. METHODS: Twenty-four consecutive patients were implanted with a multicolumn surgical lead for refractory chronic back and leg pain by using the optic transligamentar MAST technique. RESULTS: The MAST technique allowed median lead placement, facilitated visualization of the spine, and permitted transligamentar insertion that minimized scarring and muscle damage. No technique-related adverse events or lead revisions were reported. CONCLUSION: Use of a MAST approach could be useful in safe implantation of multicolumn surgical leads in difficult-to-treat, refractory lower back pain conditions such as failed back surgery syndrome.

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High-Frequency Spinal Cord Stimulation at T9/10 in Patients With Failed Back Surgery Syndrome

Neurosurgery ◽

10.1093/neuros/nyz310_705 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Naoki Higashiyama ◽

Takuro Endo ◽

Taku Sugawara

Keyword(s):

Spinal Cord ◽

Spinal Cord Stimulation ◽

High Frequency ◽

Low Frequency ◽

The Elderly ◽

Failed Back Surgery Syndrome ◽

Leg Pain ◽

Effective Treatment Option ◽

Failed Back Surgery ◽

Back Surgery

Abstract INTRODUCTION Spinal cord stimulation (SCS) is an effective treatment option for low back pain and radicular leg pain of failed back surgery syndrome (FBSS). In a recent study, high-frequency spinal cord stimulation (HFSCS) was found to be more effective in treating chronic pain than traditional paresthesia-based low-frequency SCS (paresthesia SCS). The purpose of this study is to evaluate the efficacy of paresthesia SCS and HFSCS in improving outcomes. METHODS We retrospectively reviewed the outcomes of patients who underwent paresthesia SCS or HFSCS between September 2016 and January 2019. Paresthesia SCS is generally characterized by programming stimulation parameters such that the patient experiences paresthesia, and the paresthesia topography overlaps the pain topography as much as possible. The patient in HFSCS had a placement of cylindrical lead at levels T9-10. Patients were programmed with the electrode overlying the inferior endplate of T9 (+) and the electrode overlying the superior endplate of T10 (–). RESULTS A total of 14 patients (4 males, 10 females) underwent paresthesia SCS implantation. Mean age was 77.2 ± 9.6 yr. A total of 5 patients (2 males, 3 females) underwent HFSCS implantation. Mean age was 78.2 ± 7.5 yr. Operative time was shorter for the HFSCS group compared to the paresthesia SCS group (53.4 ± 4.8 min vs 82.9 ± 20.3 min, respectively; P < .001). A total of 5 out of 5 patients in the HFSCS group (100%) and 10 out of 14 patients in the paresthesia SCS group (71.4%) achieved the outcome of 50% pain relief (P = .25) CONCLUSION To confirm paresthesia during the procedure in the elderly may be complicated by hearing/language difficulties or by sedative-related confusion. Compared to paresthesia SCS, HFSCS allows for lower operative times and a more efficient and accurate positioning of the electrodes.

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High-frequency 10 kHz Spinal Cord Stimulation for Chronic Back and Leg Pain

Clinical Journal of Pain ◽

10.1097/ajp.0000000000000866 ◽

2020 ◽

Vol 36 (11) ◽

pp. 852-861

Author(s):

Rod S. Taylor ◽

Anthony Bentley ◽

Bruce Campbell ◽

Kieran Murphy

Keyword(s):

Spinal Cord ◽

Spinal Cord Stimulation ◽

High Frequency ◽

Leg Pain

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High frequency spinal cord stimulation for chronic back and leg pain

Interdisciplinary Neurosurgery ◽

10.1016/j.inat.2020.101009 ◽

2021 ◽

Vol 23 ◽

pp. 101009

Author(s):

Sergio Torres-Bayona ◽

Salvador Mattar ◽

Maria Paula Arce-Martinez ◽

Yeiris Miranda-Acosta ◽

Hernan Felipe Guillen-Burgos ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Stimulation ◽

High Frequency ◽

Leg Pain

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Spinal Cord Stimulation for a Patient with Lower Extremity Pain due to Multiple Nerve Root Tumor associated with Neurofibromatosis Type 1

Japanese Journal of Neurosurgery ◽

10.7887/jcns.25.773 ◽

2016 ◽

Vol 25 (9) ◽

pp. 773-776

Author(s):

Yasumasa Nishikawa ◽

Mitsuhiko Ohata ◽

Kenji Suzuki ◽

Akira Ogawa ◽

Kuniaki Ogasawara

Keyword(s):

Spinal Cord ◽

Lower Extremity ◽

Neurofibromatosis Type 1 ◽

Nerve Root ◽

Spinal Cord Stimulation ◽

Neurofibromatosis Type ◽

Lower Extremity Pain

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High Frequency Spinal Cord Stimulation for Complex Regional Pain Syndrome: A Case Report

January 2018 - Pain Physician ◽

10.36076/ppj.2017.1.e177 ◽

2017 ◽

Vol 1 (21;1) ◽

pp. E177-E182

Author(s):

Alan D. Kaye

Keyword(s):

Spinal Cord ◽

Case Report ◽

Complex Regional Pain Syndrome ◽

Spinal Cord Stimulation ◽

High Frequency ◽

Therapeutic Option ◽

Low Frequency ◽

Pain Syndrome ◽

Leg Pain ◽

Caucasian Woman

Complex regional pain syndrome (CRPS) is a chronic, debilitating, neuropathic pain condition which is often misdiagnosed, difficult to manage, and lacks proven methods for remission. Most available methods provide some relief to a small percentage of patients. Recent FDA approval and superiority of the Nevro Senza 10-kHz high frequency (HF10) spinal cord stimulation (SCS) therapy over traditional low-frequency spinal cord stimulation for treatment of chronic back and leg pain may provide a new interventional therapeutic option for patients suffering from CRPS. We provide a case report of a 53-year-old Caucasian woman who suffered with CRPS in the right knee and thigh for over 7 years. Implantation of the HF10 device provided over 75% relief of pain, erythema, heat, swelling, and tissue necrosis to the entire region within 1 month of treatment. Because the HP10 therapy provides pain relief without paresthesia typical of traditional low-frequency, this system may provide relief for patients suffering from chronic pain. Key words: Complex regional pain syndrome, spinal cord stimulation, Nevro Senza HF10, erythema, knee, thigh

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Anterograde and Retrograde Epidural Paddle Placement Through a Single Laminotomy for the Treatment of Back and Lower Extremity Pain Using Spinal Cord Stimulation: Case Reports and Technical Note

Neuromodulation Technology at the Neural Interface ◽

10.1111/ner.12158 ◽

2014 ◽

Vol 17 (8) ◽

pp. 766-770 ◽

Cited By ~ 1

Author(s):

Alexander Taghva

Keyword(s):

Spinal Cord ◽

Lower Extremity ◽

Spinal Cord Stimulation ◽

Case Reports ◽

Technical Note ◽

Lower Extremity Pain

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Wireless High-Frequency Spinal Cord Stimulation (10 kHz) Compared with Multiwaveform Low-Frequency Spinal Cord Stimulation in the Management of Chronic Pain in Failed Back Surgery Syndrome Subjects: Preliminary Results of a Multicenter, Prospective Randomized Controlled Study

Pain Medicine ◽

10.1093/pm/pnz019 ◽

2019 ◽

Vol 20 (10) ◽

pp. 1971-1979 ◽

Cited By ~ 3

Author(s):

Robert Bolash ◽

Michael Creamer ◽

Richard Rauck ◽

Payam Vahedifar ◽

Aaron Calodney ◽

...

Keyword(s):

Spinal Cord ◽

Chronic Pain ◽

Spinal Cord Stimulation ◽

High Frequency ◽

Low Frequency ◽

Failed Back Surgery Syndrome ◽

Leg Pain ◽

Trial Period ◽

Failed Back Surgery ◽

Back Surgery

Abstract Background This study aimed to evaluate the wireless Freedom Spinal Cord Stimulator (WSCS) System for the treatment of chronic back and/or leg pain associated with failed back surgery syndrome (FBSS) refractory to standard medical treatment utilizing 10-kHz stimulation (high-frequency [HF]) in comparison with 10–1,500-Hz stimulation (low-frequency [LF]) waveforms. Methods Ninety-nine subjects were randomized in a 1:1 ratio to receive either HF or LF stimulation waveforms utilizing the same Freedom WSCS System. All subjects were implanted with two 8-electrode arrays in the exact same anatomical positions within the dorsal epidural spinal column, with the top electrode positioned at the T8 and T9 vertebrae levels, respectively, and the wireless receiver placed under the skin in a subcutaneous pocket. Results Seventy-two (HF: N = 38; LF: N = 34) subjects had completed the six-month follow-up after an initial 30-day trial period at the time of this report. For both the HF and LF arms, mean visual analog scale (VAS) scores for back and leg pain decreased significantly: 77% and 76%, respectively, for the HF arm and 64% and 64%, respectively, for the LF arm. In addition, most subjects experienced significant improvements in VAS, Oswestry Disability Index, European Quality of Life 5 Dimension questionnaire, Patient Global Impression of Change, and sleep duration. Conclusions These preliminary results demonstrate that WSCS devices can reduce FBSS chronic pain substantially with both LF and HF stimulation waveforms over a seven-month period (30-day trial period and six-month post-trial evaluation).

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