Resident Physician NewYork Presbyterian - Columbia & Cornell New York, New York, United States
Case Diagnosis: 38-year-old female with intractable back pain following spinal fusion surgery
Case Description: 38-year-old female with a history of previous spine surgery (T6-L3 fusion with Harrington Rods at age 15 for adolescent idiopathic scoliosis) presented to the pain clinic with right-sided low back pain described as aching and sharp pain without radiation. Patient reported no alleviating factors and pain exacerbated by standing, bending, twisting, and walking. Prior to presentation, the patient was treated with numerous interventions such as right-sided lumbar medial branch block (L4-L5), epidural spinal injection (L4-L5), right sacroiliac joint injections, aborted spinal cord stimulation trial due to difficult lead placement, physical therapy, and medication management all with minimal relief of symptoms. Patient opted to proceed with temporary peripheral nerve stimulation (PNS).
Discussions: Procedure: PNS leads were implanted using fluoroscopy with the patient in a prone position. Two leads were introduced 2 cm lateral from midline at a 90-degree angle to target the medial branch nerve over the lamina at the right L4-L5 level. After confirming pain relief, the lead introducers were removed, and the percutaneous leads were connected to an external pulse generator. Programming involved 6-12 hours of cyclical multifidus activation daily for 60 days. After lead placement, the patient experienced 100% pain relief for six months according to a visual analog scale.
Discussion: This case offers insights into the potential clinical utility of PNS as an effective therapeutic approach for managing and providing lasting improvements in refractory back pain, particularly in individuals with spinal surgery who had limited response to conservative treatments. Additional research can explore the potential for introducing percutaneous PNS earlier in the treatment process for this chronic process.
Conclusions: Given the significant pain relief the patient reported, the use of peripheral nerve stimulation for intractable back pain in patients who have failed conservative measures may be a viable option.
