Thoracic Spine Degeneration Following Microlaminotomy for Spinal Cord Stimulator Placement and Subsequent Removal—a Case Report

Excerpt

Spinal cord stimulators (SCSs) have become increasingly popular as a treatment modality for neuropathic pain since their first description in 1967 [16]. Neuropathic pain can occur in the setting of spinal disease or in other conditions such as complex regional pain syndrome (non-spinal etiology of neurogenic pain). Neuropathic pain after spinal surgery may result from a variety of factors such as postoperative microinstability, epidural fibrosis, depression, residual or recurrent disc herniations, or intrinsic nerve cellular changes and has become a complex and expensive challenge for modern healthcare [2]. The increased incidence reported after complex surgery has not been ameliorated by the advances made in minimally invasive surgery [14, 15]. Patients with neuropathic pain stemming from spinal surgery are reported to have a decreased quality of life and frequently fail to find pain relief from conservative medical treatment modalities when compared to patients with chronic pain of another origin [17]. SCSs have been shown in limited studies to increase patients’ quality of life and functional capacity while decreasing leg- and low back pain and utilization of analgesic medication. However, SCS results in increased costs to the health system over conventional therapies for these diagnoses [8, 10]. The placement of SCSs after prior spinal surgery is frequently complex due to prior fusions and laminar overgrowth as well as epidural scarring which may prevent or complicate both the percutaneous placement of single-column leads as well as the microsurgical placement of wide paddle leads. Wide paddle leads offer broader terminal coverage and more numerous programming algorithms but require a more invasive microlaminotomy for insertion. Placement of leads above the cephalad extent of fusion may be required. If prior fusion extends to the upper lumbar segments, this may require thoracolumbar insertion of leads. …