BACKGROUND: Neuropathic pain after spinal cord injury (SCI) is common and often refractory. Closed-loop spinal cord stimulation (CL-SCS) is a novel intervention that adjusts stimulation based on evoked compound action potentials in real time, but its use for pain in complete SCI is not well described.

CASE REPORT: A 45-year-old man with complete C6-C7 SCI developed severe, diffuse neuropathic pain below the injury level refractory to multiple medications, an intrathecal fentanyl pump trial, and ketamine infusions. With extensive epidural scarring, a staged buried CL-SCS trial with a combined open/percutaneous approach implanted bilateral C2-C5 leads. Trial stimulation produced complete analgesia. After internalization, pain improved to 4/10 on the Numeric Rating Scale at 3 months, with sustained 50-60% subjective improvement through 12 months. A wound complication at 11 months prompted surgical washout. Persistent concern for device colonization ultimately led to explantation at 18 months.

CONCLUSIONS: CL-SCS may provide meaningful, sustained analgesia and functional benefit in select patients with complete cervical SCI. Systematic studies are needed to quantify benefit, durability, and risk.

KEYWORDS: Spinal cord stimulation, cervical spinal cord injury, closed-loop, evoked compound action potential, neuropathic pain, open-loop, refractory pain