ECAP-Guided Closed-Loop Spinal Cord Stimulation for Axial Thoracic Pain: A Case Report

Thoracic spine pain is among the least commonly reported pain syndromes. Conventional therapeutic strategies are frequently ineffective and may be associated with adverse events. Closed-loop spinal cord stimulation (SCS) assisted with evoked compound action potentials (ECAPs) has emerged as a promising, safe and effective alternative. In this case report, we describe the successful use of ECAP-controlled closed-loop SCS in a patient with refractory thoracic spine pain. A female patient in her 40s presented with several axial thoracic pain refractory to all conservative and interventional therapies. Upon admission, the numeric rating scale (NRS) for pain score was 8/10. Functional limitations included restricted sleep duration (3 h) and limited standing and walking tolerance (20 min). The patient underwent a one-week trial of ECAP-controlled closed-loop SCS, during which 24 million smart adjustments were automatically performed to maintain consistent neural activation. The dose accuracy was ±5 μV, with a target ECAP of 19.4 μV, and the measure was 16.4 μV, and the patient used the device 100% of the time. Following treatment, the patient reported improvement in pain and functional outcomes, with NRS scores decreasing to 2/10, and substantial improvements in sleep (6 h), standing, and walking duration. This case suggests that ECAP-assisted closed-loop SCS may provide meaningful pain relief and functional improvements in patients with refractory spine pain.