1500 - Chronic post-laminectomy radicular lower extremity dysesthesias secondary to arachnoiditis successfully treated with closed loop spinal cord stimulator

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

JP

Justin E. Pratte, DO

PGY3 Resident
University of Connecticut PM&R Residency Program
Newington, Connecticut, United States

Co-Author(s)

GH

Gage Hurlburt, DO

Resident physician
University of Connecticut Physical Medicine & Rehabilitation Residency Program
Windsor, Connecticut, United States
IN

Isabel Nip, MD, MS

Resident Physician
University of Connecticut/Hartford Hospital/Gaylord Specialty Healthcare
West Hartford, Connecticut, United States

Corresponding Author(s)

DG

David E. Gutierrez, MD

Assistant Professor
UCONN School of Medicine and Frank H. Netter MD School of Medicine
Hartford, Connecticut, United States

Submitter(s)

JP

Justin E. Pratte, DO

University of Connecticut
Newington, Connecticut, United States

Case Diagnosis: Chronic post-laminectomy radicular lower extremity dysesthesias secondary to arachnoiditis

Case Description: 69-year-old female presented for residual left foot neuropathy despite back and lower extremity pain relief status-post L4-L5 hemilaminectomy and discectomy four months prior. She failed physical therapy with hydroelectric stimulation. MRI demonstrated enhancing granulation tissue spanning the anterolateral, lateral, and posterolateral epidural space, and an enhancing annular fissure with disc bulge and endplate spurring abutting the L5 descending nerve root. The clinical picture was consistent with arachnoiditis and post-laminectomy syndrome. Neurosurgical intervention was not recommended. Patient underwent L4-5 epidural steroid injection without symptom relief. She then opted to pursue spinal cord stimulator (SCS) placement with a 12 contact percutaneous lead system. SCS trial provided >75% symptom relief and improved daily function, so a permanent closed-loop spinal cord stimulator positioned superiorly at T6-T7 extending to T11-T12 was placed. At 3-month follow-up, the patient reported continued significant relief.

Discussions: Recognized as causes of persistent pain after spinal surgery, arachnoiditis and post-laminectomy syndrome are often refractory to conventional management and are indications for SCS. While refractory pain has long been treated with open-loop SCS, the constant stimulation parameters of its fixed-output design limit adaptability. Closed-loop SCS represents a significant advancement, utilizing evoked compound action potentials that dynamically adjust stimulation intensity and provide more consistent analgesia. In this case, closed-loop SCS successfully alleviated neuropathic symptoms refractory to conservative and interventional measures, underscoring its potential role in managing post-laminectomy arachnoiditis.

Conclusions: Closed-loop stimulation offers a promising, adaptive neuromodulation strategy for arachnoiditis and post-laminectomy pain. Further research is needed to validate long-term outcomes and broader clinical applications.