Pain
Stacey Chung, MD
PM&R Resident Physician
JFK JRI
Bayonne, New Jersey, United States
Alexander Shustorovich, DO
Associate Program Director, Pain Medicine and Assistant Professor for Department of PM&R
JFK Johnson Rehab Institute, Center for Sports and Spine Medicine
Edison, New Jersey, United States
Shirley Shen, MD
Pain Fellow
JFK Medical Center
Edison, New Jersey, United States
Aimee Abbott-Korumi, DO
Physical Medicine and Rehabilitation Resident
JFK-Johnson Rehabilitation Institute
Edison, New Jersey, United States
Stacey Chung, MD
JFK JRI
Bayonne, New Jersey, United States
A 54-year-old female with post-laminectomy syndrome
Case Description:
A patient with a L5-S1 right laminotomy and left lower extremity DVT who presented to pain management clinic with low back and bilateral lower extremity pain. History and physical examination was consistent with bilateral L5-S1 lumbar radiculopathy, despite negative EMG and NCS. The patient had failed multiple interventions including bilateral L5/S1 transforaminal epidural steroid injections, medial branch blocks, yoga, physical therapy, and activity modification. She endorsed decreased efficacy of oral medications and impairments in ADLs and sleep. The patient underwent spinal cord stimulation (SCS) trial, and at follow-up 8 days later, she endorsed at least 50% symptom relief, with significant improvement in sleep. She was planned for permanent SCS implantation, but did not follow up until 14 months later as she was 100% pain-free. At that follow-up, she only endorsed intermittent left lower extremity paresthesias, and physical examination was unremarkable.
Discussions:
Post-laminectomy syndrome is characterized by persistent and refractory back and/or lower extremity pain despite lumbosacral spine surgery. One treatment option is SCS, a neuromodulation technique to alter nerve activity through targeted delivery of electrical stimuli. A randomized controlled trial found that SCS was significantly more successful than reoperation with at least 50% pain relief and satisfaction in 47% of patients who received SCS as opposed to 12% of patients who received reoperation. A pre-implant trial is the standard of care to determine the utility/prognosis of a permanent SCS based on expert clinical guidance. There is no evidence to suggest that a trial would lead to long-term pain relief.
Conclusions:
This is the first case that suggests a SCS trial can result in long-term pain relief, directly contradicting recent discussions of potential benefits for direct SCS implantation. Further research is needed to modify the traditional trial-to-implant paradigm.
