Case report
Paddle lead cervical spinal cord stimulation for failed neck surgery syndrome

https://doi.org/10.1016/j.clineuro.2013.07.002Get rights and content

Introduction

Spinal cord stimulation (SCS) is a reliable treatment option for chronic pain conditions such as failed back surgery syndrome (FBSS) and complex regional pain syndrome (CRPS) [1], [2]. However the use of SCS has thus far been limited largely to the thoracic spine, with enthusiasm for cervical SCS tempered by the challenge of securing an electrode in this inherently more flexible region. Paddle leads have here provided some advantages over percutaneous leads, minimizing lead migration. Yet, the role of cervical SCS has largely remained unexplored, particularly in patients with Failed Neck Surgery Syndrome (FNSS). We employ the term FNSS to describe patients that have persistent, medically intractable pain of the upper extremities and/or neck despite having had at least one prior cervical spine operation for degenerative disease, and exclude patients who have developed an iatrogenic CRPS. Such patients may present ideal candidates for cervical neuromodulation. We herein briefly review our experience with cervical SCS for FNSS.

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Case report

A Boolean search of our electronic medical record system was conducted for all patients that underwent cervical SCS by a single neurosurgeon (J.J.M.) at our institution. Medical records were reviewed; patients were included in the study if they were found to have FNSS, defined by 2 criteria for this study: (1) medically intractable pain of the upper extremities and/or neck originating from degenerative spine disease, and (2) at least one prior cervical spine operation. All patients considered

Discussion

This study was an attempt to review the efficacy and long-term satisfaction outcomes of cervical spinal cord stimulation for patients with FNSS, performed by a single surgeon (J.J.M) at a single center. Within our small study group, six of eight patients that underwent trial cervical SCS were implanted with permanent paddle leads. At the time of questionnaire follow-up, there was unanimous satisfaction among all 6 of these patients with the SCS. A close inspection of these patients’ responses

Conclusion

Neuromodulation via cervical SCS appears to hold promise in ameliorating the incapacitating pain that patients with FNSS routinely experience. The results of our study are encouraging insofar as they suggest that when appropriately indicated, SCS has the capacity to achieve immensely satisfying patient outcomes. The relatively short duration of relief experienced nonetheless, reflects the technological limitations of the treatment modality. Research into the mechanisms of loss of effectiveness

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