dorsal column stimulator paddle placement

Most brachial plexus avulsion injuries are traumatic in origin, mainly caused by motor vehicle accidents or industrial injuries. Permanent paddle cervical spinal cord stimulation. On 1-month follow-up, the patient continued to report a good coverage of his pain with no recurrence. An SCS with paddle-type leads was placed by a neurosurgeon covering the area from C3 to C5 (Figure 0002). Decision was made to proceed with implantation of a permanent stimulator. On his follow-up visit, the patient reported a 50% reduction in pain intensity and was satisfied with the result. We fixed the stimulator in place and asked the patient to monitor the efficacy of the stimulator on decreasing his pain level and improving his quality of life and to return to the clinic in 3 days. With stimulation the patient reported a decrease in his pain level with complete coverage of his right upper extremity and right shoulder. The electrodes were covering the area from C3 to C6 (Figure 0001). Under fluoroscopy guidance, we advanced the lead until the tip was seen at the C3 level. We entered the epidural space at C7-T1 level using a paramedian approach. Decision was made to proceed with a cervical spinal cord stimulator trial. Medical management with a combination of an antidepressant, an anticonvulsant, a nonsteroidal anti-inflammatory medication, and an opioid failed to improve his pain. He was not interested in functional recovery and was only concerned about relieving the pain. On examination, he had no sensation or motor function below the deltoid. He described his pain as burning, stabbing, and sometime like an electric shock, starting at the shoulder and radiating to the arm and his five fingers, with an intensity of 7/10 on a numeric pain rating scale.

He lost sensation and motor function below the deltoid in his right upper extremity, however his main debilitating problem was severe chronic pain. Magnetic resonance imaging (MRI) showed complete nerve root avulsion from C6 to T1. He suffered from multiple injuries including injury to his right brachial plexus. We report a case of significant improvement in pain from brachial plexus avulsion injury after implanting a cervical SCS.Ī 25-year-old male patient was involved in a motor vehicle accident 5 years ago. Cervical spinal cord stimulation (SCS) is one of the underutilized treatment modalities with several reports of good outcome.

However, in most cases, the pain is resistant to medical treatment and has a high-recurrence rate after invasive procedures like dorsal root entry zone (DREZ) lesioning. The pain can be treated medically or with more invasive surgical procedures. Almost 80% of patients with brachial plexus avulsion develop chronic pain.

Dorsal column stimulator paddle placement