Cervical Spinal Cord Stimulation for the Management of Pain from Brachial Plexus Avulsion

Abstract

Dear Editor, Almost 80% of patients with brachial plexus avulsion develop chronic pain. The pain can be treated medically or with more invasive surgical procedures. However, in most cases, the pain is resistant to medical treatment and has a high-recurrence rate after invasive procedures like dorsal root entry zone (DREZ) lesioning. Cervical spinal cord stimulation (SCS) is one of the underutilized treatment modalities with several reports of good outcome. We report a case of significant improvement in pain from brachial plexus avulsion injury after implanting a cervical SCS. A 25-year-old male patient was involved in a motor vehicle accident 5 years ago. He suffered from multiple injuries including injury to his right brachial plexus. Magnetic resonance imaging (MRI) showed complete nerve root avulsion from C6 to T1. He lost sensation and motor function below the deltoid in his right upper extremity, however his main debilitating problem was severe chronic pain. He described his pain as burning, stabbing, and sometime like an electric shock, starting at the shoulder and radiating to the arm and his five fingers, with an intensity of 7/10 on a numeric pain rating scale. On examination, he had no sensation or motor function below the deltoid. He was not interested in functional recovery and was only concerned about relieving the pain. Medical management with a combination of an antidepressant, an anticonvulsant, a …