![]() ![]() Although spinal cord stimulation is a controversial option for the treatment of central neuropathic pain, 1 this therapeutic alternative was considered, offered and accepted on the basis of a few successful case reports. Despite all the efforts, pain continued to be intractable. She was referred to the pain clinic, where she was treated with multiple oral and topical agents (gabapentin, pregabalin, topiramate, amitriptyline, nortriptyline, sertraline, naproxene, tramadol, oxycodone, hydromorphone, methadone and capsaicin), and experienced severe adverse effects including sedation, cognitive dysfunction and imbalance. Post-operative electromyography/nerve conduction studies (EMG/NCS) revealed basically normal findings except for absent response from the lateral femoral cutaneous nerves. The patient received cervical spinal radiation over the course of the next four months. The patient was taken to surgery for additional tumor resection with discectomy and arthrodesis of C5-C7. ![]() Persistent pain after surgery required a new MRI that showed focal enhancement in C6-C7 with spinal canal stenosis secondary to disc protrusions. The lesion was excised through a cervical laminectomy. She reported a sense of tightness in the chest accompanied by diaphoresis and intermittent loss of sphincter control.Ī magnetic resonance imaging (MRI) study revealed an intramedullary tumor at C6 (ependymoma) with associated syringomyelia above and below the lesion (C5-T2) ( Fig. Case reportĪ forty-nine year-old female patient was assessed by the neurosurgery service for pain in the left hemithorax radiating to the ipsilateral upper limb and the inter-scapular region. Successful symptom control was achieved after thoracic SCS. The following is the case of a female patient in whom the resection of a cervical ependymoma with associated syringomyelia led to intractable pain of the lower limbs. SCS is considered as a viable therapeutic option for the management of peripheral neuropathic pain, but its use in central pain is controversial with only a limited number of successful cases reported. Spinal cord stimulation (SCS) may be beneficial for patients with intractable pain. After multiple therapeutic modalities have failed, including pharmacological and non-pharmacological options, improvement of symptoms is improbable. Neuropathic pain following spinal cord injury may pose a clinical and therapeutic challenge. ![]()
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