Dorsal Column Spinal Cord Stimulation for Sacral Radiculopathy Due to Sacroiliac Joint Fusion to Hardware: A Case...

A complication of sacroiliac joint (SIJ) fusion is neuropathic pain due to intruding hardware.

We present the novel management of a 57-year-old man who presented with S1 radiculopathy that began immediately after SIJ fusion, which had been performed 2 years prior. Physical exam and electromyography confirmed right S1 radiculopathy. Imaging confirmed hardware protrusion into the S1 neural foramen. The patient failed conservative management, and an outside tonic spinal cord stimulator trial (SCS) trial, but experienced 100% relief during the anesthetic phase of S1 transforaminal epidural steroid injections. A neurosurgical consult deemed the patient to be an inappropriate candidate for surgical revision due to the complete fusion of the hardware to bone. The patient successfully underwent a burst SCS trial with 100% relief as measured by the Numeric Rating Scale and increased his quality of sleep and activity with subsequent permanent implantation.

SCS utilizing burst stimulation can offer a unique treatment option for resultant neuropathic pain from SIJ fusion to hardware in the event that surgical revision is not recommended.