Intractable sacroiliac joint pain treated with peripheral nerve field stimulation

Chakrabortty, Shushovan; Kumar, Sanjeev; Gupta, Deepak; Rudraraju, S

doi:10.4103/0970-9185.173336

Cited by 12 publications

(13 citation statements)

References 10 publications

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“…Injection techniques are commonly used to diagnose and treat the painful SIJ 59 – 65 , with fluoroscopy-guided techniques being more accurate 66 . Peripheral nerve stimulation 67 , 68 and low-level laser therapy 69 have evolved as treatment options. Similarly, nerve ablation techniques 70 – 75 and surgical interventions using both open 76 – 78 and minimally-invasive approaches 55 – 58 , 79 have yielded promising results concerning patient outcomes 80 .…”

Section: Discussionmentioning

confidence: 99%

Pelvic orthosis effects on posterior pelvis kinematics An in-vitro biomechanical study

Klima

Grunert

Ondruschka

et al. 2018

Sci Rep

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The sacroiliac joint (SIJ) is a well-known source of low back pain, with increasing interest for both conservative and surgical treatment. Alterations in pelvis kinematics are hypothesized as a contributor to SIJ pain and pelvic orthoses one treatment option, but their effects on the pelvis are poorly understood. Alterations in movement patterns induced by the application of pelvic orthoses were determined in five human cadaveric pelvises. Deformations were obtained from the lumbosacral transition and the bilateral SIJ, using digital image correlation and a customized routine to compute the movements within the pelvis. Significant alterations were found for the movements at the SIJ, in particular a vast increase in axial (x-axis) rotation, accompanied by increased inferior (y-) translation of the sacrum relative to the ilium. Movement patterns at the lumbosacral transition changed, causing increases in axial rotation and decreased inferior translation of L5 relative to S1. Using a physiologic mode of load application gives novel insights into the potential effects of pelvic orthoses. The results of these in-vitro experiments vary markedly from previous experiments with loading limited to two or less axes. Furthermore, the influence of pelvic orthoses on the lumbosacral transition warrants further investigation.

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Section: Discussionmentioning

confidence: 99%

Pelvic orthosis effects on posterior pelvis kinematics An in-vitro biomechanical study

Klima

Grunert

Ondruschka

et al. 2018

Sci Rep

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“…The use of PNFS, also known as subcutaneous field stimulation, for sacral and coccygeal pain has not been previously reported. There are reports of using PNFS for iliac crest and sacroiliac pain with single and dual electrodes [ 4 , 8 , 9 ]. Nerve field stimulation evolved from the original concept of localized stimulation targeting specific branches of peripheral nerves.…”

Section: Discussionmentioning

confidence: 99%

“…Subcutaneous electrodes have been implanted for different regional pain syndromes including post-herpetic pain, intercostal pain, hip and knee pain, trochanteric bursitis, post-joint replacement pain and for pain at iliac bone graft sites [ 4 , 9 ]. Some authors have used ultrasound guidance to position the electrodes in the deep fascia but in this case all leads were placed under fluoroscopic guidance [ 4 , 7 , 8 ]. There are both individual case reports and small series of patients that show significant relief using peripheral nerve or field stimulation for intractable axial lumbar pain as well as for post-laminectomy pain [ 4 - 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…PNFS has also been combined with spinal cord stimulation to target axial postsurgical back pain when the patient also has more lateralized pain at an iliac crest graft site or along the greater trochanter for hip pain that cannot be reached with an intraspinal lead [ 10 ]. Dual parallel subcutaneous leads give a broader area of stimulation [ 7 , 8 ]. When the leads are made to communicate by programming different polarity at the same level this creates a current between the parallel leads, which has been labeled as 'cross-talk'.…”

Section: Discussionmentioning

confidence: 99%

“…The use in patients with post-laminectomy pain has had mixed results because of difficulty getting the electrode in dense para-spinal scar and uncertainty regarding if the electrode should be placed paramedian and vertical or horizontal across the incision and midline [ 6 ]. Positioning parallel electrodes is necessary to create interlead communication which broadens the stimulation field, however, the exact distance between leads that will still allow cross lead communication has not been established [ 7 , 8 ]. This case reviews the use of PNFS for chronic previously intractable coccygeal pain.…”

Section: Introductionmentioning

confidence: 99%

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Bilateral Peripheral Nerve Field Stimulation for Intractable Coccygeal Pain: A Case Study Using Dual Lead Intercommunication

Granville

Brennan

Jacobson

2017

Cureus

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Coccygeal pain is a difficult chronic pain problem with mixed response to various treatments. This is a report of a case of coccygeal pain that after failing various conservative and interventional procedures over five years was evaluated with a temporary peripheral sacral fascial lead followed by implantation of bilateral sacral paramedian leads for peripheral nerve field stimulation (PNFS). This resulted in marked pain control and resumption of full activity. The visual analog scale (VAS) pain score improved from eight pre-implant to one after implant and has remained at that level in follow-up. Peripheral nerve field stimulation has been reported for axial chronic back pain, post-laminectomy pain and sacroiliac joint pain either alone or in conjunction with epidural spinal cord stimulation. Both single and parallel leads have been used to provide wider stimulation but differences in location have not been examined. This is the first case report of the use of PNFS for treatment of intractable chronic coccygeal pain. The effectiveness of PNFS was established for this patient by using a prolonged 10-day temporary trial period followed by a 30-day interval without stimulation during which the pain returned to the pre-trial level before proceeding with permanent implantation, it was clear that in this case, PNFS was effective for pain control. Interestingly, the trial and permanent leads were both in the posterior sacral fascia but not in identical positions yet equally effective for pain control. The observation of the effectiveness of different positions may indicate that at least for peripheral field stimulation there may be significant current spread in the fascia. Two and three months after the implant, we examined the effect of different lead settings and the effect of unilateral stimulation compared with bilateral stimulation with and without interlead communication. The patient feedback in this case provides some understanding of the effect of field stimulation with different lead placements. A trial of a deep peripheral fascial lead for sacral and coccygeal field stimulation is a simple option and may be a reasonable approach to consider in the range of treatments for chronic coccygeal pain.

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Neurostimulationsverfahren

Tronnier¹

2018

Neurochirurgische Schmerztherapie

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Intractable sacroiliac joint pain treated with peripheral nerve field stimulation

Cited by 12 publications

References 10 publications

Pelvic orthosis effects on posterior pelvis kinematics An in-vitro biomechanical study

Pelvic orthosis effects on posterior pelvis kinematics An in-vitro biomechanical study

Bilateral Peripheral Nerve Field Stimulation for Intractable Coccygeal Pain: A Case Study Using Dual Lead Intercommunication

Neurostimulationsverfahren

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