David A Provenzano1, Joseph R Williams1, Gaye Jarzabek1, Leonard A DeRiggi2, Thomas F Scott3. 1. Pain Diagnostics and Interventional Care, Sewickley, PA, USA. 2. Brighton Radiology Associates, Heritage Valley Sewickley Hospital, Sewickley, PA, USA. 3. Director Multiple Sclerosis Treatment Center of Allegheny General Hospital, Drexel University School of Medicine, Pittsburgh, Sewickley, PA, USA.
Abstract
OBJECTIVE: To report a case with two years follow-up of neuropathic pain and functional limitations associated with multiple sclerosis (MS) effectively treated with an MRI conditional spinal cord stimulator (SCS) system that allowed for spinal imaging. To present a comprehensive literature review of spinal cord stimulator utilization in the treatment of multiple sclerosis. DESIGN: Case report and literature review. INTERVENTION: Treatment was a spinal cord stimulation implant after successful trial. Pain scores, medication utilization, and functional outcomes were reviewed. Pre- and post-SCS implant MRI spine images were obtained. RESULTS: At 24 months follow-up, the patient has had a 77% reduction in pain and a 99% reduction in opioid use. Furthermore, he had improvement in reported tactile sensation, spasticity levels, and ambulation. Post-SCS implant, MRI images at 18 months follow-up provided the ability to review the spinal cord with minimal artifact. No new MS documented plaques occurred during this time period. A literature review demonstrated 33 published reports including a total of 496 trialed and 744 implanted patients. Only 3 of the reports occurred after the year 2000. CONCLUSIONS: We report the successful treatment of MS-associated pain and functional limitations with an MRI conditional spinal cord stimulator system. The ability to obtain post-implant MRI imaging of not only the brain but also the spinal cord in MS patients allows for the continued need to document and follow disease progression, especially with the advancements in pharmacological therapy.
OBJECTIVE: To report a case with two years follow-up of neuropathic pain and functional limitations associated with multiple sclerosis (MS) effectively treated with an MRI conditional spinal cord stimulator (SCS) system that allowed for spinal imaging. To present a comprehensive literature review of spinal cord stimulator utilization in the treatment of multiple sclerosis. DESIGN: Case report and literature review. INTERVENTION: Treatment was a spinal cord stimulation implant after successful trial. Pain scores, medication utilization, and functional outcomes were reviewed. Pre- and post-SCS implant MRI spine images were obtained. RESULTS: At 24 months follow-up, the patient has had a 77% reduction in pain and a 99% reduction in opioid use. Furthermore, he had improvement in reported tactile sensation, spasticity levels, and ambulation. Post-SCS implant, MRI images at 18 months follow-up provided the ability to review the spinal cord with minimal artifact. No new MS documented plaques occurred during this time period. A literature review demonstrated 33 published reports including a total of 496 trialed and 744 implanted patients. Only 3 of the reports occurred after the year 2000. CONCLUSIONS: We report the successful treatment of MS-associated pain and functional limitations with an MRI conditional spinal cord stimulator system. The ability to obtain post-implant MRI imaging of not only the brain but also the spinal cord in MS patients allows for the continued need to document and follow disease progression, especially with the advancements in pharmacological therapy.
Authors: Laura D Wandner; Brenda T Fenton; Joseph L Goulet; Constance M Carroll; Alicia Heapy; Diana M Higgins; Matthew J Bair; Friedhelm Sandbrink; Robert D Kerns Journal: J Pain Res Date: 2020-07-07 Impact factor: 3.133