ID: 204376 Pectus Excavatum Intercostal Neuralgia Relief With Peripheral Nerve Stimulation

Abstract

Pectus excavatum, the posterior displacement of the sternum and adjoining ribs into the thoracic cavity, is the most common anterior chest wall deformation (1). Its incidence has been estimated to occur in 1 in 40 to 1 in 400 births (1). Moderate to severe cases of pectus excavatum are often associated with chronic sternal and chest wall pain, dyspnea, restrictive lung disease, and cardiovascular compression (2). In recent years, intercostal nerve cryoablation during surgical correction of pectus excavatum via the Nuss procedure has been associated with a shorter hospital length of stay, decreased opioid usage, and longer duration of chest numbness particularly in adults (3). Intercostal neuralgia is commonly treated with oral medications and single shot injections; however, pain relief can be unsatisfactory or short-lived in refractory cases. Despite the development of neuromodulation in treatment of various pain syndromes, there are only scant case reports on using spinal cord stimulation and no study on using peripheral nerve stimulation to treat intercostal neuralgia from pectus excavatum. In this case report, we describe a 69-year-old woman with a history of chronic chest wall pain secondary to pectus excavatum who found pain relief with peripheral nerve stimulation at the T4 nerve root bilaterally after minimal pain relief with physical therapy, multiple neuropathic agents, and chronic opioids.