Pain
Elijah J. Sosa, n/a
Medical Student
University of California Irvine School of Medicine
Murrieta, California, United States
Courtney Smith, DO
Resident Physician
University of California Irvine School of Medicine
Orange, California, United States
David Ho, DO
Resident Physician
University of California Irvine School of Medicine
Orange, California, United States
Alexa Lean, MD
Physician
University of California Irvine School of Medicine
Orange, California, United States
Elijah J. Sosa
University of California Irvine School of Medicine
Murrieta, California, United States
Chronic back pain in patients with a history of thoracic fusion managed with spinal cord stimulation (SCS) utilizing nontraditional lead placement.
Case 1: A 55-year-old female with T10–L2 fusion extended to L4 and prior SCS placement presented with post-laminectomy syndrome. She achieved five years of pain relief with SCS but developed disc re-herniation necessitating revision surgery. She developed intractable lumbar pain, leading to SCS re-implantation with a nontraditional approach. Given her thoracic fusion, leads were inserted via a superior, paraspinous technique at the T8–9 interlaminar space, advanced to T5. At 20-day follow-up, she reported 70% reduction in pain, improvements in sleep and mobility, decreased reliance on analgesics, and increased participation in physical therapy.
Case 2: A 63-year-old male with T10–L3 fusion for T12 burst fracture presented with intractable back pain leading to SCS. Given his thoracic fusion, leads were inserted using a superior, paraspinous approach at the T9-10 interlaminar space, advanced to T7. At 18-day follow-up, he reported 80% pain reduction and higher functionality, though later complicated by lead migration.
Spinal cord stimulators are an established treatment for conditions including failed laminectomy syndrome and intractable low back pain. Standard SCS for lumbar pain is typically performed at the T12–L1 or L1–L2 interlaminar space. In thoracic fusion cases, SCS lead placement often requires higher thoracic entry due to altered postsurgical anatomy, decreased epidural space, and scar tissue, which increases complication risk. These two cases highlight that despite anatomical challenges, unconventional SCS implantation in chronic back pain can lead to significant pain relief, improved function, reduced analgesic reliance, and enhanced participation in rehabilitation.
Nontraditional, higher thoracic SCS lead placement can be an effective treatment for managing chronic back pain and improving functionality in patients with extensive thoracic fusion.
