Lhermitte’s phenomenon pain relieved with spinal cord stimulation
Alexander E. Yakovlev, MD, Angela M. Parmentier, APNP • Comprehensive Pain Management of the Fox Valley, SC 820 East Grant Street, Suite 335 • Appleton, Wisconsin, USA
Introduction:
Lhermitte’s phenomenon characterizes an electric-shock like sensation felt down the spine when the head is flexed forward. Following movement a transient, short-lasting, electric shock-like sensation extends down the spine and shoots into the limbs. Pain from Lhermitte’s phenomenon is typically brief, lasting seconds, and feels “electrical” in nature. Sixty year old male underwent anterior cervical discectomy, decompression, and interbody structural allograft fusion and plating of C5-C6, had resolution of Lhermitte’s phenomenon characteristics for less than one year. Repeat cervical imaging showed a stable fusion with multi-level posterior disc bulges, central canal stenosis, and neural foraminal narrowing at C5-6. Lumbar imaging significant for degenerative changes, without disc displacement. With complaints of returning shooting pains in his lower extremities with head movements, spinal cord stimulation (SCS) was trialed and successful at relieving the pain experienced in his legs.
Methods:
Single case study of patient who underwent SCS trial and later implantation with two temporary eight-electrode leads at T9, T10 and T11.
Results:
After experiencing excellent pain relief, including complete resolution of lower extremity pain over the two day trial period, the patient was implanted with permanent leads, and a RestoreSensor rechargeable generator (Medtronic Inc., Minneapolis, MN) with adaptive stimulation sensor and reports sustained pain relief.
Usage:
Uses stimulation 24 hours per day.
Pain relief:
Patient reports leg pain was reduced by 100% from baseline, and 75% of axial back pain relieved.
Satisfaction:
Patient is 100% satisfied with SCS therapy and would recommend to a friend.
Opioid usage:
Patient completely eliminated use of opioids.
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Conclusion:
Based on the outcomes observed and its reversible nature, SCS represents an attractive treatment option for patients with intractable pain in lower legs induced with cervical rotation.
Reference:
Lhermitte, JJ, Polak, Nikolas, M. Les douleurs a type discharge electrique consecutives a la flexion cephalique dans la sclerose en plaques. Un cas de la sclerose multiple. Revue neurolgique; (1924) 2:56-57.
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