41 year old male with back and leg pain
A healthy 41 year old man presents to clinic with a history of continued back and leg pain following multiple lumbar spine surgeries, most recently an L4-5 laminectomy with L3-S1 fusion. He states that both legs are equally painful, and the leg pain exceeds the back pain. He cannot tolerate pregabalin or duloxetine. Gabapentin helps somewhat but he cannot tolerate a higher dose than that which he currently takes.
Medications: Gabapentin 300 mg PO TID, Lovastatin, Tramadol 50 mg PO Q6Hrs PRN
Strength is 5/5, DTR trace bilaterally in lower extremities. Lumbar spine slightly tender to palpation.
The patient undergoes and electromyogram, and this is consistent with a chronic bilateral L5-S1 radiculopathy. There is no active denervation noted.
The patient’s pain management provider offered a spinal cord stimulator trial. After placement of percutaneous leads and one week of trial stimulation, the patient reported 85% relief of his leg and back pain.
After a discussion of risks, benefits, and alternatives the patient elected to undergo placement of a paddle-type spinal cord stimulator placed via laminotomy. Following the procedure he reported excellent relief of his leg and back pain.