Retrograde Epidural Spinal Cord Stimulation for the Treatment of Intractable Neuropathic Pain Following Spinal Cord and Cauda Equina Injuries: A Case Report and Literature Review

Abstract

Spinal cord stimulation (SCS) offers an alternative treatment for refractory pain resulting from various etiologies. Generally, SCS electrodes are inserted in an anterograde fashion, moving from caudal to rostral direction. However, there are instances where anterograde placement is unfeasible due to technical limitations. We present the use of retrograde surgical electrode placement in SCS for a patient with extensive epidural fibrosis at the site intended for electrode insertion. A 48-year-old female suffering from refractory neuropathic pain caused from injuries to the conus medullaris and cauda equina opted for SCS. During the SCS trial procedure, challenges emerged when attempting percutaneous electrode insertion at the site of a prior T12 laminectomy. However, the trial stimulation resulted in significant pain relief. For the permanent placement of the stimulator, utilizing a surgical electrode centered at T11 vertebral level, a considerable amount of epidural fibrosis was encountered at the entry of the spine, particularly at the T12 vertebral level. To avoid dural injury and ensure accurate electrode positioning, a retrograde technique for surgical electrode was employed via partial laminectomies at the T9-T10 level. The final electrode positioning was in accordance with the preoperative plan, well-centered at the T11 vertebral level. The patient experienced sustained relief from neuropathic pain over the long term. Retrograde epidural SCS is a suitable option for cases characterized by extensive epidural fibrosis resulting from a previous spinal surgery or when the anterograde placement of the electrode is unattainable due to aberrant vertebral anatomy.