Difficult Single-Lead Spinal Cord Stimulator Trial for Failed Back Surgery Syndrome Salvages Treatment

Spinal cord stimulation (SCS) is a minimally invasive neuromodulation treatment modality primarily used for failed back surgery syndrome (FBSS), complex regional pain syndrome, and diabetic neuropathy. Specifically, when utilized for the treatment of FBSS, placement can be complicated by the excessive scarring, adhesions, and altered anatomy limiting the access to the epidural space and advancement of the leads.

Our patient is a 58-year-old woman with a history of scoliosis and severe lumbar spinal stenosis who presented for trial of an SCS for FBSS. Given the refractory nature to medical and minimally invasive management, an SCS trial was performed. Unfortunately, due to the extensive fibrosis and adhesions in her epidural space, only a single lead could be placed but experienced pain relief. During the permanent SCS, 2 leads were successfully placed with the patient ultimately receiving > 50% pain relief.

Here, we present a case of FBSS refractory to medical and minimally invasive management where a single SCS lead was placed during the trial, due to scarring and adhesions, and 2 leads during the permanent SCS procedure. Our case report suggests considering even the trial of a single-lead placement during an SCS trial in patients with an otherwise difficult anatomy, as the placement of the permanent lead offers greater access to the epidural space potentially allowing for the placement of a second lead and potentially salvaging the entire therapy.