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The following case study was written for Medtronic with consultation from:
Ralph Rashbaum, M.D. Suzanne Alfano, R.N. Clinical History and Presentation In November 1990, this 36-year-old female nursing aide was injured on the job while lifting a patient. She was referred to the Texas Back Institute for evaluation and rehabilitation. X-rays and a computed tomographic (CT) scan later that month revealed a herniated disc on the left side. Physical therapy, anti-inflammatory agents, and epidural cortisone injections over the next few months failed to provide relief. In January 1991, a laminectomy/discectomy was performed at the L5-S1 level, and physical therapy was attempted again. The patient experienced some relief for three months following the surgery. However, the burning pain in her back and left leg returned, with the addition of a new symptom: numbness of the sole of her left foot. Additional diagnostic testing revealed no further pathology.Over the course of the next year, functional rehabilitation and physical therapy were again attempted. A steroid injection brought partial relief for one month. With her back pain as her primary complaint, the patient received steroid injections into the facet joints of the spine in May 1992. While this reduced her back pain, her leg pain and numbness in the sole of her foot were still troublesome. With the radicular, burning nature of her leg pain, and the reduction of her back pain, neurostimulation was considered. In July 1992, she underwent extensive psychological screening and was determined to be an appropriate candidate for neurostimulation. [Top]Neurostimulation: Evaluation and Results In September 1992, she was hospitalized for a neurostimulation screening test. A Medtronic Pisces Quad Plus® lead, a percutaneous lead that provides broad coverage, was inserted into the epidural space at the T11-12 level using local anesthesia and hypnotherapy. The patient experienced good paresthesia coverage in her left leg and foot, with 90% pain reduction in those areas. During the next two days in the hospital she continued to experience excellent pain relief. On the third day of her stay, the neurostimulation system was internalized. A Medtronic Itrel® II neurostimulator was implanted using local anesthesia, hypnotherapy, and Versed® with morphine. The system was connected to the neurostimulator and tested again, with the same level of pain relief achieved as in the screening test. Six-months post-implantation the patient reported 100% pain relief in her leg and foot. Although she continues to have some back pain, she is able to be very active without any additional pain medication. She is currently being re-trained for other work.  
[Top] Discussion and Conclusion Additional surgery in this patient was not warranted as an extensive battery of tests failed to identify any problem which could be surgically corrected. Steroid injections into the facet joints of the spine significantly reduced her back pain. However, the burning, radiating, leg pain and numbness of the sole of her foot continued. Neurostimulation resulted in 100% relief of her leg pain. This has allowed her to become active again, without additional pain medication.Individual results may vary. Not every individual will experience the same benefits. See Important Safety Information and Risks for information about the risks associated with neurostimulation. [Top]To see Patient Selection for Intrathecal Drug Delivery. . . To see Patient Selection for Neurostimulation . . . [Top]   IntroductionAbdominal
PainArachnoiditis
and Fibrosis PainBack
and Bilateral Leg PainCancer
PainChronic
Back and Leg PainComplex
Regional Pain Syndrome (CRPS)Dual-Site
Mixed PainIntractable
Thoracic Pain  Post-Laminectomy
Syndrome |
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