High-Frequency Cervical and High Thoracic Spinal Cord Stimulation to Treat Refractory Failed Back Surgery Syndrome in a Patient with Chronic Neck and Low Back Pain: Case Report

Abstract

BACKGROUND: Failed back surgery syndrome (FBSS) is defined as lumbar spinal pain of unknown origin that persists following surgical intervention or newly presents after spine surgery (1). This pain may originate from surgery, or the surgery may worsen or insufficiently reduce prior pain (1). From 2004 to 2015, the volume of lumbar fusion surgery increased by 62.3% (2). With the frequency of lumbar fusion surgery comes an increased propensity to develop FBSS. The risk of developing FBSS in patients who have undergone lumbar spine surgery is as high as 50% (3). Spinal cord stimulation (SCS) is a well-established, safe, and effective treatment modality for refractory neuropathic pain conditions such as FBSS (4). CASE REPORT: A 47-year-old patient presented to the clinic with a history of cervical radiculopathy status post C4-C7 posterior spinal fusion, lumbar radiculopathy, lumbar spinal stenosis, congenital spondylolisthesis status post L5-S1 anterior lumbar interbody fusion complicated by a malpositioned screw at the L4-L5 level, L4-L5 retrolisthesis, L5-S1 pseudoarthrosis with subsequent T10 to pelvis fusion, which was later extended to T8 after a fall. The patient developed FBSS resulting in debilitating neck and low back pain. Permanent SCS with leads at C7-T3 were placed without complication. The SCS implant resulted in successful treatment of FBSS with an 80% reduction in pain scores, 86% reduction in MME consumption, and an improvement in performance of activities of daily living. CONCLUSION: This case highlights the use of SCS leads placed over the low cervical and high thoracic levels for the treatment of cervical and lumbar back pain. Due to the complex surgical history of the patient, a unique lead implantation location spanning C7-T3 was required. This lead location is significantly cephalad to the typical lead implantation location of T8-L1 for the treatment of chronic lumbar back pain, as the T8-L1 levels are where neurons responsible for back pain are most heavily concentrated (5). This case highlights the effectiveness of SCS therapy implanted at an atypical location for the treatment of FBSS. KEY WORDS: Atypical cervical and thoracic spinal cord stimulation, case report, chronic refractory neck and low back pain, failed back surgery syndrome, neuromodulation