Publication Date
9-1-2024
Journal
Cureus
DOI
10.7759/cureus.68901
PMID
39381474
PMCID
PMC11458553
PubMedCentral® Posted Date
9-7-2024
PubMedCentral® Full Text Version
Post-print
Published Open-Access
yes
Keywords
chronic pain management, chronic post surgical pain, complex regional pain syndrome, implanted hardware, pedicle fracture, s: percutaneous spinal cord stimulation, spinal cord stimulator
Abstract
Spinal cord stimulation (SCS) has emerged as a novel therapeutic option for refractory complex regional pain syndrome (CRPS). However, SCS placement is often complicated by a prior history of surgical manipulation and hardware implantation along the spinal column. Through this case exploration, we aim to expand the technical approach to SCS implantation in CRPS and encourage further research into innovative approaches for this treatment modality. Our patient is a 61-year-old female with a past medical history of bilateral C7 cervical pedicle fracture status and extensive surgical manipulation, including cervical laminectomy and hardware placement along the cervical spine. The development of CRPS refractory to conventional therapies complicated her course. We obtained non-contrast computed tomography (CT) to confirm intact lamina in vertebral levels below C3 and proceeded with the SCS trial with successful lead placement up to C5. Despite prior surgical manipulation of the vertebral spine hindering our ability to access the ideal C2 level, we were able to achieve significant coverage up to the C5 level. Obtaining non-contrast CT preoperatively and carefully assessing the epidural space patency were integral to our ability to assess the feasibility of lead placement in a patient with extensive hardware. Through this approach, we are able to offer SCS to patients who would otherwise be precluded from this modality.