Successful Use of Subcutaneous Stimulation for Bilateral Sacroiliac Joint Pain

Abstract

Sacroiliac joint pain (SIJP) has been difficult to properly manage in the medical field. Patients are initially managed with medications and physical therapy but may require further interventions including intraarticular corticosteroid injections, radiofrequency ablation, and sacroiliac joint fusion. Although peripheral nerve stimulation (PNS) and peripheral field nerve stimulation (PFNS) have been used with varying success, subcutaneous spinal cord stimulation (SCS) has not yet been utilized. We present the case of a patient with bilateral SIJP who had successful resolution with the use of subcutaneously-implanted SCS electrode leads.A 74-year-old female patient with a history of lumbar stenosis status post epidural steroid injection and minimally invasive lumbar decompression presented with year-long chronic low back pain (LBP) with unsuccessful pain relief from medical management and physical therapy. On physical exam, pain elicited with tenderness over both sacroiliac joints with positive Patrick's and Gaenslen's test bilaterally. After successful pain relief from a diagnostic SI joint injection, the patient underwent an SCS trial. Trial SCS leads were placed epidurally at T7 and subcutaneously next to bilateral SI joints. Epidural stimulation provided no pain relief after three days. Stimulation was then changed to the subcutaneous leads, with subsequent 90% pain relief. The patient then underwent a permanent implant with subcutaneous lead placement without complications. She reported pain relief ongoing for two years. SIJP is a difficult condition to treat despite various modalities. Recent advances in neuromodulation have shown anecdotal success with PNS. SCS involves electrode leads placed in the epidural space to provide axial back and radicular pain coverage. In this case, however, SCS leads were placed subcutaneously with excellent pain relief. Our case showcases the successful use of subcutaneous-implanted SCS which can provide another viable minimally invasive treatment option in the management of this pain source.