Peripheral Nerve Field Stimulation for Treatment of Pain Related to Spine Deformities

Peripheral Nerve Field Stimulation for Treatment of Pain Related to Spine Deformities

Alexander E. Yakovlev, M.D. and Beth E. Resch, APNP, Comprehensive Pain Management of the Fox Valley, SC, Appleton, Wisconsin, Appleton, WI

Introduction: Patients with spine deformity often have chronic intractable pain. Deformity in the cervical spine, hyperlordosis or swan neck deformity, or deformity in the thoracolumbar spine, kyphoscoliosis, may require surgical intervention to straighten and stabilize the spine. Despite surgery, pain may continue. Use of PNFS may be beneficial to treat pain associated with these conditions. PNFS has been used to treat patients with injuries to a specific nerve,1 including application to occipital,2 ilioinguinal,3 supraorbital, and trigeminal neuralgia. PNFS utilizes percutaneous placement of leads in the area of pain and direct stimulation of the region of affected nerves.

Methods: A 63 year-old female with kyphoscoliosis of the thoracic and lumbar spine had previously failed conservative therapies, injections and two surgical fusions. She underwent successful trial of two 8-electrode percutaneous leads positioned in the subcutaneous tissue in the area of greatest pain in the paraspinal areas of the lumbar region. Two weeks later the patient underwent implantation of four 4-electrode permanent and RestoreULTRA (Medtronic Inc., Minneapolis, MN) rechargeable generator.

An 81 year-old female with swan neck deformity of the cervical spine and chronic neck and shoulder pain had previously failed conservative therapies and injections. She underwent successful trial of two 8-electrode percutaneous leads positioned in the subcutaneous tissue in the area of greatest pain in the paraspinal areas of the cervical region. Three weeks later the patient underwent implantation of two permanent 8-electrode leads and RestorePrime (Medtronic Inc., Minneapolis, MN) non-rechargeable generator.

Results: After final implantation both patients reported almost 100% pain relief with permanent stimulator. The first patient was able to decrease use of pain medications and the second patient was able to discontinue use of pain medications.

Conclusion: PNFS appears to afford good pain relief for patients who exhausted traditional and surgical interventions for chronic pain related to spinal deformities.

References

1. Novak CB, Mackinnon SE. Outcome following implantation of a peripheral nerve stimulator in patients with chronic nerve pain. Plast Reconstr Surg 2000;105:1967-1972.

2. Slavin KV, Nersesyan H, Wess C. Peripheral neurostimulation for treatment of intractable occipital neuralgia. Neurosurgery 2006;58:112-119.

3. Stinson LW Jr, Roderer GT, Cross NE, Davis BE. Peripheral subcutaneous electrostimulation for control of intractable post-operative inguinal pain: a case report series. Neuromodulation 2001;4:99-104.