Combined use of Intrathecal Therapy and Sacral Nerve Stimulation for Post-laminectomy Syndrome
A. Yakovlev, MD; L. Fields, APNP; and, A. Parmentier, APNP
Comprehensive Pain Management of The Fox Valley, Appleton, WI, USA
Introduction: Intrathecal pumps (ITP) have become a valuable tool in managing intractable non-cancer pain.
Intrathecal therapy have proven successful at improving pain patients with severity and decreased oral opioid
consumption. Two years after ITP pump placement patients low back and lower extremity pain was no longer
adequately covered with the ITP, despite rotation of opioid, and addition of Bupivacaine.
Methods: This 54 year old man presents with a long history of chronic low back and leg pain due to post-
laminectomy syndrome (PLS) failed conservative therapy , multiple injections and spinal cord stimulator trial.
The decision was made to proceed with implantation of an ITP after efficacious trial. Unfortunately, pain in
both leg and low back started to come back, despite escalating titration of Intrathecal Hydromorphone and
additional Bupivacaine. Decision to proceed with SNS trial. During the trial two 8 electrode leads were
inserted through sacral hiatus into epidural space with final lead positioned between S1 and S4. Patient
reported resolution in the pain in his low back and legs during the trial and after implantation of SNS.
Results: Results: The patient reports sustained pain relief in low back and bilateral lower extremities with
the use of intrathecal therapy and SNS. Patient is no longer receiving any oral opioid analgesics.
Conclusions: SNS should be considered in patients with intrathecal delivery systems to cover intractable
pain when all other treatments fail. SNS can be an effective adjunct therapy to an intrathecal system.
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