Dorsal Column Stimulation for the Treatment of Refractory Thoracic Radiculopathy: A Case Report

Abstract

Between 1996-2016, low back and neck pain expenditures amounted to $134.5 billion according to the Journal of the American Medical Association. Spinal Cord Stimulation (SCS) has been used with success in treatment of radiculopathy, peripheral nerve injury, diabetic neuropathy, failed back surgery syndrome, and complex regional pain syndrome. [1] Initially, low-frequency SCS was used and worked by activating large-diameter Ab fibers in the dorsal column, creating paresthesia stimulation at low frequency (120 Hz), high amplitude, and long duration. This was based on the Gate Control Theory so the low-rate pulsed energy applied at the certain vertebrae of the spine would activate A-beta fibers, which would gate out the nociceptive sensations carried by A-delta and C fibers. Then high-frequency stimulation was used with a frequency of 10,000 Hz, low amplitude, and short duration. This selectively activates inhibitory interneurons in the dorsal horn which suppresses wide dynamic range neurons, which are hyperactive in chronic pain. [2] High frequency stimulation has been found to be superior to low frequency in a RCT with 24 month data showing sustained relief [3].