May 2019

41 year old male with back and leg pain

History:

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.

PMH: Hypercholesterolemia

Medications: Gabapentin 300 mg PO TID, Lovastatin, Tramadol 50 mg PO Q6Hrs PRN

Exam:

Strength is 5/5, DTR trace bilaterally in lower extremities. Lumbar spine slightly tender to palpation.

Course:

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.

Mid-sagittal CT of the lumbar spine

T2 sagittal and representative axial images of the lumbar spine

Trial film supplied by patient’s pain management physician.

Intraoperative image during placement of stimulator paddle.

Questions

 
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