Disclosures: Derek H. Bui, DO: No financial relationships or conflicts of interest

Case Diagnosis: Cervical, thoracic, and lumbar radiculopathies

Case Description: A 39-year-old male who suffered a fall after electrocution was evaluated for neck pain radiating into the bilateral hands, thoracic pain radiating into the bilateral ribs, and low back pain radiating into the bilateral legs. MRI demonstrated multilevel disc protrusions resulting in diffuse nerve impingement. Pain was refractory to multiple modalities, including physical therapy, adjuvant and opioid medications, epidurals, stellate ganglion block and ketamine infusion. Neurosurgery offered him anterior cervical discectomy with fusion and lumbar laminectomy, but he sought a second opinion from Interventional Pain. Cervical spinal cord stimulation (cSCS) was offered to capture his most severe cervical and thoracic radicular symptoms. During the trial, cSCS using burst stimulation captured bilateral cervical and thoracic radicular pain but also lumbar radicular pain as well. After receiving 80% relief of all radicular symptoms, the patient proceeded with implantation for sustained relief.

Setting: Outpatient Interventional Pain PM&R clinic.Assessment/

Results: At 4 months post-implant, the patient reported significant pain relief (80-90%), functional improvement, and improved quality of life.

Discussion: Spinal cord stimulation is an accepted and effective treatment for neuropathic and sympathetically-mediated pain. Furthermore, burst stimulation has been shown to be superior to tonic stimulation when assessing pain improvement based on the visual analogue scale. Classically, lead placement is dictated by region of pain, such as radicular pain or intercostal neuralgia, but to our knowledge, there have been no reports of cSCS successfully treating diffuse cervical, thoracic and lumbar radicular pain. The success of burst stimulation in this case may be related to its proposed supraspinal neuromodulatory effects and emulation of naturally occurring neuronal firing modes in the central nervous system. Further studies examining supraspinal mechanisms of spinal neuromodulation are warranted.

Conclusion: cSCS with burst stimulation may be an effective treatment for multi-regional neuropathic pain.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/treatment-of-diffuse-cervical-thoracic-and-lumbar-radiculopathies-in-a-patient-who-suffered-electrocution-with-cervical-spine-cord-stimulation/