Spinal Cord Stimulation and Sacral Nerve Stimulation for FBSS with Significant Low Back Pain
Alexander E. Yakovlev, MD; Alexander Timchenko, MD; Angela M. Parmentier, APNP • Comprehensive Pain Management of the Fox Valley, SC
820 East Grant Street, Suite 335 • Appleton, Wisconsin, USA
INTRODUCTION
Spinal cord stimulation (SCS) for Failed Back Surgery Syndrome (FBSS) is a proven method of therapy, especially in patients with persistent leg pain. Low back pain is also often present; in the following case, initially the patient underwent SCS, which significantly reduced her pain for several years with leads positioned at were positioned in posterior epidural space to the level of T8, T9, and T10. Unfortunately, her low back pain worsened and was no longer able to be covered with placement of epidural leads positioned in the thoracic or lumbar spine. A combination of spinal cord and sacral nerve stimulation (SCS) was successfully trialed and implanted providing substantial coverage and localized pain control.
METHODS
The patient is a 29-year-old female with a history of lumbago, lumbar radiculopathy, lumbar disc displacement who underwent several injections including lumbar epidural steroid blocks and SI joint injection that gave her limited pain relief. Initially after placement of SCS, she had excellent control of pain in both her lower extremities and adequate relief of low back pain. After several months, patient reported progression of her low back pain. Several attempts at reprogramming the SCS were made, at the settings where when we covered the low back pain areas fully, the patient experienced discomfort in the abdomen and in both flanks. Decision was made to proceed with SNS trial. Patient reported well-controlled pain during trail of SNS and was implanted with permanent device.
RESULTS
The patient underwent a combination of SCS and SNS with conclusive results (VAS reduction from 6-7/10 to 2/10, as well as the ability to decrease her opioid pain medication). Since permanent placement of both devices, patient is reporting sustained pain relief in both her low back and both legs without unpleasant stimulation in her flank or abdomen. Patient uses both devices 24 hours a day.
CONCLUSIONS
Our case provides further evidence that SNS is a viable therapeutic option for patients with low back pain who have failed SCS trials with lead placement in the thoracic epidural space.
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