Treatment of Cervical Radiculopathy and Ischemic Leg Pain with Use of Spinal Cord Stimulation
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:
Patients with cervical radicular symptoms may suffer from intractable pain and functional incapacitation despite conservative measures and surgical interventions. Control of the pain even is more difficult to achieve if these types of patients have additional source of pain. Ischemic leg pain in the patients who exhausted all conventional and operative treatment also is difficult to manage. Spinal cord stimulation (SCS) has been used to treat patients with cervical radiculopathy and peripheral vascular disease (1, 2). We report combined treatment of cervical radiculopathy and ischemic limb pain with one SCS system.
Materials and Methods:
A 64-year-old male with history of intractable cervical radiculopathy and ischemic leg pain who failed conservative, surgical treatment and multiple injections. He underwent successful trial of percutaneous placement of two 8-electrode epidural leads (Medtronic Inc., Minneapolis, MN). Epidural access was gained at the T3/T4 interspace with final leads positioned at C3, C4, C5 and C6 (Figure 1). During SCS trial patient reported greater than 90% improvement of the pain not only in the neck and arm but in the legs despite the presence of paresthesias in upper but not in lower extremities. Two weeks later he underwent placement of Restore Sensor rechargeable generator.
Results:
After final implantation patient had excellent pain relief for 12 months with combined treatment of neck, arm and lower extremity pain. He was able to discontinue use of all oral pain medications. He had improvement of functional capacity. The patient’s claudication distance increased from less than 20 m to more than 300 m.
Figure legend:
Conclusion:
SCS can be effective option in the management of severe combine pain and lead to functional improvement for patients who have limited medical or nonpharmacologic options.
Reference:
1. Ghajar AW, Miles JB. The differential effect of the level of spinal cord stimulation on patients with advanced peripheral vascular disease in the lower limbs. British Journal of Neurosurgery 1996:12:402-408.
2. Tiede JM, Huntoon MA. Review of spinal cord stimulation in peripheral arterial disease. Neuromodulation 2004:7:168-175.
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