Sacral Nerve Stimulation for treatment of Lumbar Postlaminectomy Syndrome
Alexander E. Yakovlev, MD, Angela M. Parmentier, 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 of advanced postoperative changes. Report in this case study is 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:
71- year female with 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 considerable pain relief over the three days trial period, and was implanted 2 weeks later with permanent leads and Restore Ultra (Medtronic Inc.) rechargeable generator. Patient discontinued all opioid and non-opioid pain medication, and continues to report sustained pain relief.
Usage:
Uses stimulation 16+ hours per day.
Pain relief:
Patient reports sacral pain was reduced by 85% from baseline. Feels stimulation into anterior and posterior thigh covering her hip pain.
Satisfaction:
Patient is 100% satisfied with SCS therapy and would recommend to a friend.
Figure legend:
Figure 1. Two eight electrode leads placed through 14-gauge Tuohy needles into caudal space.
Figure 2. Final lead position between S1 and S4.
Figure 3. An incision created in the sacrococcygeal area for placement of the Touhy needles and leads.
Conclusion:
SNS until now used to be effective treatment of chronic pelvic and perineal pain, bowel and bladder dysfunction, but may represent an alternative treatment option to select patients with PLS and intractable low back and upper leg pain that have exhausted conservative therapies, unsuccessful with interventional pain techniques including SCS, or who are not a good surgical candidate.
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