Spinal cord stimulation in patients suffering from chronic pain after surgery for spinal intradural tumors: A case report and literature summary

Abstract

Background:The prevalence of pain after treatment of a spinal intradural tumor is remarkably high, approximately up to 40% of the patients suffer from central neuropathic pain. Publications on spinal cord stimulation (SCS) and its effect on pain caused by intradural spinal tumors are rare. We discuss the case of a patient suffering from chronic pain after removal of a Th7 level meningioma who was successfully treated with SCS and give an overview of the literature.Methods: MEDLINE database was searched for neuropathic pain and intradural tumors. Results:The initial search identified 35 articles, including hand-searched manuscripts. Six articles were included for analysis.Case Report: A 57-year-old female suffers from neuropathic pain in both legs after surgical removal of a Th7 level intradural meningioma. Postoperative magnetic resonance imaging shows no gross abnormalities, although she developed chronic pain in both legs. Pain in combination with side effects of analgesic intake are too disabling to have decent quality of life. A successful implantation of SCS is achieved at Th5 level as a treatment for the central neuropathic pain, and, at 36 months follow-up, there is significant pain relief and almost complete discontinuation of analgesics.Discussion: Central pain from spinal intradural tumors may have a different mechanism of origin than pain seen after an acute spinal cord injury (SCI).However, the basic principles of neuromodulation are the same in both etiologies, as for successful stimulation intact pathways in the spinal cord are necessary. The efficacy of SCS as treatment in intradural spinal tumors is rarely described as only a handful of case reports are published. Interestingly, the case reports show that stimulation both above and below the lesion can be effective. In patients with incomplete SCI or intradural tumor resection stimulation below the lesion could be considered and tried in a trial setting before definitive implantation.

Neurostimulation for Spinal Lesions: Enhancing Recovery and Axonal Regeneration

“…It is also indicated for patients who cannot undergo other surgical spinal procedures to alleviate pain following failed back surgery syndrome [23]. Recent patient cases involving spinal intradural tumors also demonstrate the efficacy of SCS in managing chronic pain as a result of tumor resections; although, the exact placement of electrodes to maximize benefits has yet to be determined [25]. Additionally, there are special considerations for deciding the candidacy of patients for SCS.…”

“…Neurostimulation has therapeutic benefits in traumatic lesions and neurodegenerative disorders, but it can further be applied to alleviate chronic pain in the context of post-surgical tumor resection. The prevalence of postoperative pain following spinal intradural tumor resection, specifically, is an overwhelmingly understated complication with up to 40% of patients suffering from chronic neuropathy [81]. Additionally, 30% of patients experience pain equal to or worse than their level of pain before the tumor resection procedure, emphasizing the severity of this issue [82].…”

“…Noordhof and colleagues also completed a case study involving a 57-year-old female with neuropathic pain in both legs following T7 level intradural meningioma resection [81]. Following T5 SCS implantation, the patient endorsed significant pain relief and minimal use of analgesics after 36 months.…”

Role of Posterior Longitudinal Ligament Complex in Spinal Deformity Secondary to Surgical Resection of the Intradural Tumor

“…The intradural tumor accounted for 30% of all primary vertebral body tumors. The main symptom of an intradural tumor is pain, headstand, and nocturnal seizures 1,2 . As microsurgery technology advances, the surgical treatment of intramedullary tumors has made great progress 3 which may improve patients' survival rates and better quality of life 4–6 .…”

“…The main symptom of an intradural tumor is pain, headstand, and nocturnal seizures. 1 , 2 As microsurgery technology advances, the surgical treatment of intramedullary tumors has made great progress 3 which may improve patients' survival rates and better quality of life. 4 , 5 , 6 However, despite the promotion of minimally invasive surgical techniques, spine deformity remains one of the serious postoperative complications of intradural tumor surgery.…”