Case Study 1
Spinal cord stimulator for severe complex region pain syndrome
32 year old male who had extensive bony and soft tissue injuries to his leg in an accident was diagnosed as severe complex regional pain syndrome.
Following the accident 5 years ago he underwent multiple operations for bony fractures and for soft tissue repair. His wounds healed and had no bony deformity. He developed “complex regional pain syndrome” in his leg. He had severe burning pain, recurrent swelling of the leg.
His sleep was disturbed every night, he had to leave his work and the pain was affecting his life in all aspects.
He was seen at a number of pain units. He underwent multiple pain procedures and was tried on all possible medications to help with the pain. None of which helped.
He underwent “spinal cord stimulation” trial to see if it helps his pain. The procedure involves inserting electrodes in the epidural space and passing mild current to “stimulate” appropriate area of the spinal cord. He had a successful trial and underwent a permanent implant (see x ray pictures). He has 90% or more pain relief, sleeps well and is back to work 4 months following his procedure.
Spinal cord stimulation is NICE recommended and evidence based treatment for
- Failed back surgery syndrome ( recurrent pain after back ( spine) operations)
- Complex regional pain syndrome
Spinal cord stimulation is also effective in ischaemic pain, pain due to painful bladder and functional problems of bladder and bowel (Fowler syndrome, constipation).
Case Study 2
Cervical Epduroplasty / Adhesiolysis
42 year female who had pain in the neck , headaches, tingling and pain in both the upper limbs much more so on the right side. All this pain was significantly affecting her life.
She had undergone a discectomy and fusion in the neck 5 years ago for similar complaints. After the surgery she improved for 1 year but the symptoms returned later. She was told that she will not benefit from a repeat surgery.
She had been tried on appropriate pain medications which gave her unacceptable side effects. They had to be discontinued.
She underwent a cervical epiduroplasty in which a semi rigid thin catheter is passed into the epidural space under x ray guidance ( x ray pictures). Contrast is injected to identify areas of adhesions. The catheter is directed in those areas and adhesions lysed (released) by injecting saline. Also some cortisone is injected in the area as local anti-inflammatory.
Following the procedure her neck pain, headaches and pain+ tingling in the arms is significantly improved. It is not interfering with her life anymore. She continues to get sustained relief for last 1 year.
If the symptoms return the epiduroplasty will be repeated.
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