Disclosures: Garrett K. Wong: Nothing to disclose

Case Description: A 65-year-old male with history of chronic bilateral facetogenic low back pain had received short-term, minimal relief with radiofrequency ablation and acetaminophen as needed. He then underwent percutaneous peripheral nerve stimulator implantation (SPR Therapeutics) for 60 days. After palpating and mapping the painful region on the patient’s skin, fluoroscopy identified the centermost vertebral segment (L4) of the marked painful region. The target for lead placement was the medial branch of the dorsal ramus as it lies along the lamina, medial and inferior to the facet joint, approximately 1 cm lateral to the L4 spinous process. The introducer was guided and advanced to a depth of 6 cm, confirmed with lateral fluoroscopic view. The stimulating probe was connected, and ultrasound imaging confirmed activation of the medial branch via multifidi contraction while stimulating in an “on-off” pattern. Next, the lead was inserted through the needle and re-tested to confirm appropriate multifidi contraction. The introducer was removed and the remaining lead was re-tested. The procedure was repeated on the right L4 lamina. Stimulation was programmed and adjusted to the patient’s comfort. After 2 months of stimulation for 6 hours/day, the leads were removed.

Setting: Tertiary care Veterans’ Affairs hospital

Patient: 65-year-old male with chronic low back pain.

Assessment/Results: Primary outcome (Pain VAS) was reduced from 7/10 at implantation to 1/10 at 1 week and 2 months post procedure (86% reduction). Secondary outcomes suggest improvements in pain interference with normal activities and with sleeping from 6 months pre-procedure to 2 months post-procedure.

Discussion: PNS may relieve facetogenic back pain, improve function, and reduce analgesic medication usage, even after leads are removed.

Conclusion: Unlike conventional neuromodulation, this innovative percutaneous outpatient approach may avoid costly/invasive surgery, incisions, anesthesia, and permanent implantation.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2019

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/percutaneous-peripheral-nerve-stimulation-for-chronic-low-back-pain-a-case-report/