Editor-in-Chief: Alaa Abd-Elsayed, MD, PhD
BACKGROUND: Spinal cord stimulation (SCS) is a widely accepted pain treatment modality for failed-back surgery, peripheral vascular disease-causing claudication pain, and complex regional pain syndrome. However, despite a rigorous patient selection, not all patients deemed as good candidates result in a successful trial, reasons often unknown. Herein, we present a case of unsuccessful SCS re-trial due to complete failure to capture in a patient with a prior successful trial, but failed implant attempt.
CASE REPORT: Patient is a 78 year-old male with multiple myeloma who was followed in the chronic pain clinic for chronic pain syndrome, cancer pain syndrome and peripheral neuropathy. Patient’s main pain complaints are left leg pain, lower back pain likely neuropathic, nociceptive pain from the underlying metastatic lytic lesions, as well as peripheral neuropathy. Medications include gabapentin, hydromorphone, and fentanyl patch.
Previously, patient underwent a successful SCS trial by his local pain physician followed by an attempt at permanent implant, which was aborted due to failure to perceive paresthesia. Recently, we proceeded with the SCS trial. The procedure itself was rather unremarkable, with both leads walked up to the mid-vertebral body of T8. However, there was failure to capture; the leads were pulled down separately to T12 with patient having no sensory response at high amplitudes at each level between T8 to T12. The trial leads were subsequently pulled out.
CONCLUSION: This complete failure to capture has never been reported and it could partially be explained due to extensive scarring/fibrosis from the prior SCS trial and implant attempt.
KEY WORDS: Spinal cord stimulator, failure to capture, central pain