Korean J Pain.  2016 Apr;29(2):123-128. 10.3344/kjp.2016.29.2.123.

Spinal Cauda Equina Stimulation for Alternative Location of Spinal Cord Stimulation in Intractable Phantom Limb Pain Syndrome: A Case Report

• Lee PM
• So Y
• Park JM
• Park CM
• Kim HK
• Kim JH

• KMID: 2365355
• DOI: http://doi.org/10.3344/kjp.2016.29.2.123

Abstract

Phantom limb pain is a phenomenon in which patients experience pain in a part of the body that no longer exists. In several treatment modalities, spinal cord stimulation (SCS) has been introduced for the management of intractable post-amputation pain. A 46-year-old male patient complained of severe ankle and foot pain, following above-the-knee amputation surgery on the right side amputation surgery three years earlier. Despite undergoing treatment with multiple modalities for pain management involving numerous oral and intravenous medications, nerve blocks, and pulsed radiofrequency (RF) treatment, the effect duration was temporary and the decreases in the patient's pain score were not acceptable. Even the use of SCS did not provide completely satisfactory pain management. However, the trial lead positioning in the cauda equina was able to stimulate the site of the severe pain, and the patient's pain score was dramatically decreased. We report a case of successful pain management with spinal cauda equina stimulation following the failure of SCS in the treatment of intractable phantom limb pain.

Keyword

Cauda equina; Lower extremity pain; Neurostimulation; Phantom limb; Phantom limb pain; Spinal cord stimulation

MeSH Terms

Amputation
Ankle
Cauda Equina*
Foot
Humans
Male
Middle Aged
Nerve Block
Pain Management
Phantom Limb*
Spinal Cord Stimulation*
Spinal Cord*

Figure

• 

  Fig. 1 (A) Fluoroscopic images of anteroposterior view. The tip of lead is placed at upper T12 vertebral body. (B) Fluoroscopic images of lateral view. The tip of lead is placed at upper T12 vertebral body.

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  Fig. 2 (A) Fluoroscopic images of anteroposterior view demonstrating the final lead position. The tip of lead is placed at upper L4 vertebral body. (B) Fluoroscopic images of lateral view demonstrating the final lead position. The tip of lead is placed at upper L4 vertebral body.

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  Fig. 3 (A) The patient's MRI images. Sagittal view of lumbar spine. (B) Transverse section at mid L4 vertebral body level, black arrow: Right L4 nerve root, white arrow: cauda equina of right L5, white arrow head: cauda equine of right sacral nerves. (C) Transverse section at mid L5 vertebral body level, black arrow: Right L5 nerve root, white arrow: cauda equina of right S1, white arrow head: cauda equine of right sacral nerves except S1.

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