Retrograde cervical insertion of spinal cord stimulator in persistent spinal pain syndrome type 2 in patient with fusion from sacrum to T10.

Introduction: Placement of a spinal cord stimulator (SCS) is a neuromodulatory technique with several indications, including persistent spinal pain syndrome type 2 (PSPS2), painful diabetic neuropathy, non-surgical chronic low back pain, and complex regional pain syndrome. SCS is conventionally placed in a caudal to cranial fashion (anterograde), yet there are cases such that spinal fusion hardware and adhesions prevent this insertion technique.

Case presentation: Our patient is a 57-year-old man with PSPS2 who had extensive spinal fusion and epidural scarring extending from the sacrum to T10. The patient trialed and failed conservative medical management for his PSPS2 pain, with limited options available for pain relief. The decision was made to place the SCS leads in a retrograde manner at C7-T1, which were then threaded to the T10 level, offering the patient complete relief of back pain and >80% of bilateral lower extremity radicular symptoms.

Conclusion: Here, we present another case in the literature of a permanently placed SCS performed in the retrograde fashion by an interventional chronic pain physician. Though the technique was off label, the retrograde approach offered the patient significant relief when all other treatment modalities failed. Despite the effective use of the retrograde approach, more studies are needed, including guidelines as to when to offer the retrograde approach for patients with inaccessible anatomy for a typical anterograde technique.