![]() ![]() A complete paraplegia below the level T5, AIS A (according to the International Standards for Neurological Classification of SCI by the American spinal cord injury society 19) was found. The patient was assessed by a neurologist to establish the neurological and pain diagnosis. Right after the onset of the sensory and motoric symptoms a burning and stabbing pain developed in both lower legs and feet. This lesion had set in due to a toxic reaction to local anesthetic which has been administered epidurally as anesthesia for elective knee surgery in 2014. 15, 16, 17, 18Ī 53-year-old female presented to our pain clinic with a 2-year history of neuropathic below-level SCI pain following a complete spinal cord lesion. The main indications for the use of SCS, preferably in a setting of interdisciplinary pain treatment, are neuropathic pain conditions such as complex regional pain syndrome (CRPS) or peripheral nerve injuries as well as mixed neuropathic/nociceptive conditions such as failed back surgery syndrome (FBSS). 13, 14 SCS is a synonym for dorsal column stimulation. Since its first mention almost 50 years ago, 12 the electrical inhibition of pain using stimulation of the spinal cord has become a well-established method in the treatment of a variety of pain conditions. ![]() Some study groups that evaluated the efficacy of SCS therapy included patients with paraplegia, unfortunately no detailed data about the paraplegia (AIS score, level of lesion) is provided. 8 In this context, very little is known about the use spinal cord stimulation (SCS). 6 Treatment options include pharmacological, interventional and psychological approaches, at the best embedded in an interdisciplinary pain treatment setting. 7 Neuropathic pain appears to be persistent despite various treatment and treatment remains difficult and inadequate. Neuropathic pain following SCI is considered as one of the most distressing and disabling complications. 5 Criteria for SCI neuropathic pain have been proposed including history of a spinal disease or lesion confirmed by a diagnostic test, pain location at or below the neurological level of injury, presence of negative or positive sensory signs in the area of pain compatible with the spinal cord or root lesion and exclusion of other pain causes. 4 Neuropathic pain is classified as ‘pain arising a as direct consequence of a lesion or disease of the somatosensory system’. 3 Among individuals with SCI and pain treated in a multidisciplinary pain centre the prevalence of neuropathic at-level and below-level SCI pain was found in 53 and 42% respectively. 2 Neuropathic pain in SCI can be classified as at-level or below-level, according to its localization referring to the level of the lesion. 1 The prevalence of neuropathic pain in a recent review is established at 53%. The prevalence of pain in general is reported in about 74% in SCI. Pain is a common complication in patients with spinal cord injury (SCI). Further investigation has to be carried out to support this theory. A modulation of suggested residual spinothalamic tract function may play a role. Mechanisms of pain relief remain unclear. Discussion:Įven in case of complete SCI, SCS might be effective. This effects lasted for at least three months of follow-up. The average pain was reduced to a bearable intensity of 4/10, in addition attacks could be reduced both in frequency and in intensity. After a successful 2 weeks testing period the pulse generator has been implanted permanently with a burst-stimulation pattern. SCS was applied below the level of injury at-level T11-L1. Pain intensity was reported on numeric rating scale with an average of 7/10 (0 meaning no pain, 10 meaning the worst imaginable pain), but also with about 8–10 pain attacks during the day with an intensity of 9/10, which lasted between some minutes and half an hour. Time and pain duration since injury was 2 years. Case presentation:Ī 53-year-old female presented with neuropathic below-level SCI pain of both lower legs and feet due to complete SCI below T5. ![]() We report a case where epidural spinal cord stimulation (SCS) below the level of injury has been successfully applied in a patient with a complete spinal cord lesion. Neuropathic pain is common in patients with spinal cord injury (SCI) and often difficult to treat. ![]()
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