title: Successful peripheral nerve field stimulation for thoracic radiculitis following Brown-Sequard syndrome.
abstract: OBJECTIVE
  The objective of this study is to present a novel approach to the treatment of thoracic radiculitis following Brown-Sequard syndrome with peripheral nerve field stimulation (PNFS). Furthermore, we endeavor to discuss the role of PNFS in the management of refractory neuropathic pain conditions including post-traumatic and post-surgical neuropathy particularly with regards to the post-surgical spine.
  
  
  METHODS
  Presented is a 57-year-old man with history of thoracic microdiscectomy resulting in Brown-Sequard syndrome presented with chronic post-operative thoracic radicular pain radiating to the abdomen, refractory to conservative management. The patient underwent three intercostal nerve blocks from T7 to T9 with transient symptomatic relief. The patient's options were limited to chemomodulation, neuromodulation, or selective intercostal nerve surgical neurectomy. He subsequently underwent a PNFS trial and reported >75% pain reduction. Permanent percutaneous PNFS electrodes were implanted subcutaneously over the right T7 and T9 intercostal nerves and replicated the trial results.
  
  
  RESULTS
  Neuromodulation produced pain relief with >90% improvement in pain compared with baseline both during the trial and following permanent implantation of the PNFS system.
  
  
  CONCLUSIONS
  Chronic radicular pain may be difficult to manage in the post-surgical patient and often requires the use of multiple therapeutic modalities. In this case, we successfully utilized PNFS as it demonstrated greater technical feasibility when compared with dorsal column stimulation and repeat surgery; therefore, it may be considered for the management of post-surgical neuropathy. Further controlled studies are needed to evaluate the efficacy of PNFS as a treatment option.
authors: George Washington University Hospital-The GW Spine & Pain Center, George Washington Medical Center, 2131 K. Street, N. W., Washington, DC 20037, USA. mdesai@mfa.gwu.edu
authors: Mehul J
authors: MJ
authors: Desai
authors: Mehul
authors: M
authors: Desai
authors: Lisa
authors: L
authors: Jacob
authors: James
authors: J
authors: Leiphart
mesh_terms: D018437:Brown-Sequard Syndrome / Q000150:complications*; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D010525:Peripheral Nerves / Q000502:physiology*; D011843:Radiculopathy / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D013904:Thoracic Vertebrae; D016896:Treatment Outcome