A unique approach to neurostimulation in patients with previous two-segment spine surgery and obstruction of epidural access for spinal cord stimulation: a case series.
BACKGROUND
Patients with extensive surgery in the lumbar and thoracic spine are often not considered for neurostimulation due to the inability to perform a conventional spinal cord stimulation (SCS) trial. We are presenting six such patients in which spinal-peripheral neurostimulation (SPN) was used via a caudal approach.


METHODS
Six patients with intractable low back and leg pain following extensive lumbar and thoracic surgeries, up to at least the T10 level, underwent a stimulation trial with one caudal lead and one subcutaneous lead in order to achieve SPN.


RESULTS
In five cases, the trial was successful with coverage of the pain area and at least satisfactory pain relief. All six patients were implanted with a paddle lead(s) and a subcutaneous lead using SPN with good pain control.


CONCLUSIONS
SPN with a caudal lead appears to be a viable option for SCS trial in patients with no possibilities for conventional trial lead placement.
Carolinas Center for Advanced Management of Pain, NC-SC, Spartanburg, SC 29306, USA.
Y Eugene
YE
Mironer
Philip J
PJ
Hodge
J Talley
JT
Parrott
Sumeer
S
Lal
Phillip C
PC
LaTourette
D000368:Aged; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D007796:Laminectomy; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D010148:Intractable Pain / Q000209:etiology / Q000628:therapy*; D013116:Spinal Cord / Q000502:physiology / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects