1501 - Spinal Cord Stimulation for Chronic Pain Syndrome Refractory to Conservative Management: A Case Report

71-year-old male with chronic pain syndrome secondary to multilevel lumbar spondylosis, spinal stenosis, and grade 1 anterolisthesis.

Case Description:

A 71-year-old male with over 10-year history of recurrent low back pain presented with worsening 6-8/10 pain that is refractory to conservative management. MRI of the lumbar spine revealed multilevel lumbar spondylosis, spinal stenosis from L2–L5, and anterolisthesis at L4–L5. The patient had tried and failed extensive conservative treatments including oral steroids, NSAIDs, opioids, epidural steroid injections, and physical therapy. Following a review of treatment options, the patient trialed a spinal cord stimulator (SCS) and achieved >50% pain relief, leading to permanent implantation of the neurostimulation device. A thoracic laminectomy was performed for paddle lead placement in the epidural space with an implantable pulse generator inserted into the gluteal region. Intraoperative testing confirmed adequate pain coverage and stimulation.

Discussions:

At 3 months post-implant, the patient continued to report >50% pain relief with decreased reliance on opioids and other analgesics. 

Spinal cord stimulation is increasingly recognized as a safe, minimally invasive and advanced treatment for patients with intractable pain lasting more than six months despite conservative management. This case demonstrates its effectiveness in reducing chronic back pain and opioid use while improving function and quality of life.

Conclusions:

Patients with chronic back pain refractory to conservative management can achieve significant pain relief and improved function with spinal cord stimulation. Early recognition of patients less likely to benefit from repeated conservative therapies allows physiatrists to facilitate timely access to advanced neuromodulation interventions, such as SCS. This will optimize patient outcomes and potentially reduce prolonged suffering.