Spinal Cord Stimulation for Intractable Pain Caused by Sacroiliac Joint Dysfunction: A Case Report.

Abstract

Sacroiliac joint dysfunction is one of the causes of lower back pain, and although it has characteristic pain locations and aggravating factors, it is difficult to diagnose and is often overlooked. A case of relief of typical pain symptoms due to sacroiliac joint dysfunction by spinal cord stimulation is presented. A 60-year-old woman presented with severe chronic pain in the left lumbar, lower buttock, iliac, and groin areas that worsened even when sitting for short periods, as well as numbness in the right lower extremity. The patient had chronic lower back pain since experiencing acute lumbosacral sprains in her 20s and 40s, and her symptoms worsened without any trigger in her 60s. Standard imaging examinations showed no lesions that could be causing the pain, and blood tests showed no inflammation or other abnormalities. Although pharmacological treatment did not provide sufficient analgesia, sacroiliac joint block provided a significant analgesic effect, leading to a definitive diagnosis of sacroiliac joint dysfunction. A spinal cord stimulation trial was performed using percutaneous 8-contact leads placed at the thoracic vertebra 8-11 level, and pain relief was confirmed. One month later, 2 new percutaneous 16-contact leads and an implantable pulse generator were implanted simultaneously. One month after implantation, the visual analog scale and the quick inventory of depression symptomatology scores decreased dramatically from 83 to 8 and from 16 to 4, respectively. In addition, the numbness of the right lower extremity disappeared. These analgesic effects were sustained for 12 months.