ID:16022 Neuromodulation for Neuropathic Pain Secondary to Cervical Ependymoma Resection

Abstract

Chronic neuropathic pain is a widespread condition in which patients often fail pharmacological treatment. Advancements in invasive neuromodulation techniques are providing a wide range of applications that can significantly improve the quality of life for patients that suffer from progressive neuropathic pain unresponsive to conventional medical treatments. We present a case of a 62-year-old female with a history of cervical ependymoma status-post resection and three-year history of chronic cervical and lumbar pain as well as neuropathic symptoms including burning, numbness, and weakness in all four extremities. In addition, the patient had concerns for neurogenic bowel and bladder incontinence. These symptoms developed immediately status-post cervical laminectomy in 2017 which was performed for her C3-C4 ependymoma resection. Extensive work-up of her symptoms from multiple specialties and treatment regimens had been largely unsuccessful. Pain Management was consulted and a spinal cord stimulator trial using both a cervical lead and lumbar lead greatly reduced the patient’s pain in all extremities as well as her bowel and bladder symptoms. Four months after full implantation of a cervical and lumbar spinal cord stimulator, the patient rates a consistent 70% reduction in overall pain. She also reports significant reduction with neurogenic bowel or bladder incontinence. This case highlights spinal cord stimulation as a viable treatment option for refractory neuropathic pain of multiple origins and presentations, including multi-level spinal cord targeting such as presented in this case of post-laminectomy changes.