Resolution of Low Back Pain After Implantation of Sacral Nerve Stimulator
Alexander Yakovlev, MD; Angela Parmentier, APNP; Lynda Fields, APNP • Comprehensive Pain Management of the Fox Valley, SC
820 East Grant Street, Suite 335 • Appleton, Wisconsin, USA
INTRODUCTION
The pain of patients with postlaminectomy syndrome (PLS) is difficult to control despite conventional treatments and especially when procedures like spinal cord stimulation (SCS) are not feasible because advanced postoperative changes. We report successful treatment of the low back and leg pain related to PLS of the patient with sacral nerve stimulation (SNS) employing a caudal approach.
METHODS
A 71-year-old female with a 12-year history of PLS had minimal relief with conservative medication management and multiple injections. SCS trial was attempted with entry into the epidural space on several levels from T11-12 down to L2-3, but failed because of severe postoperative and degenerative changes. She underwent successful trial with percutaneous placement of two 8-electrode leads (Medtronic Inc.) through the sacral hiatus into epidural space with final lead electrode positioned between S1 and S4.
RESULTS
During SNS trial, the patient reported excellent pain relief, including complete resolution of low back and right leg pain. Patient reported 100% pain relief over the three-day trial period, and was implanted two weeks later with permanent leads and Restore Ultra (Medtronic Inc.) rechargeable generator. Patient was initially able to discontinue all opioid medication, and reported pain relief with device. After seven months, patinets reported resolution of her leg pain and low back pain and SCS system was shut off.
CONCLUSIONS
Until now, SNS used to be effective treatment of chronic pelvic pain, bowel and bladder dysfunction but may represent an alternative treatment option to select patients with PLS and intractable low back and leg pain who have exhausted conservative therapies and interventional pain techniques including SCS.
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