Ventral Column Spinal Cord Stimulation for Postlumbar Laminectomy Syndrome

Spinal cord stimulation is an increasingly used treatment for a number of chronic pain states. Dorsal column stimulation is historically and currently the anatomical target of choice for most chronic pain conditions, including postlaminectomy syndrome and radicular pain. However, early studies suggested that stimulation of an alternative target, the ventral columns that carry pain fibers in the anterior and lateral spinothalamic tracts, may offer comparable or superior pain relief. A patient undergoing standard-of-care spinal cord stimulation trial had an additional lead placed on the right ventrolateral aspect of the spinal cord. After the usual 7-day trial of dorsal column stimulation, the dorsal leads were removed and ventrolateral column stimulation was applied through the retained ventral lead for a period of 3 days. The Brief Pain Index Short Form and Numeric Rating Scale were recorded for both dorsal and ventral stimulation. Ventrolateral spinal cord stimulation provided comparable outcomes compared with dorsal column stimulation using nonparesthesia-based stimulation. The results suggest further investigation into spinal cord stimulation anatomical placement and mechanism of action is warranted.