Successful spinal cord stimulation using fast-acting sub-perception therapy for postoperative neuropathic pain of syringomyelia with Chiari malformation type 1: a case report and literature review

• Published in: BMC neurology 2024-08, Vol.24 (1), p.284-5, Article 284
• Main Authors: Yamana, Satoshi, Oiwa, Ayano, Nogami, Ryo, Fuga, Michiyasu, Kawamura, Daichi, Nakayama, Yosuke, Sano, Tohru, Murayama, Yuichi, Ohashi, Hiroki
• Format: Article
• Language: English
• Subjects: Adults; Aged; Analgesics; Arnold-Chiari Malformation - complications; Arnold-Chiari Malformation - surgery; Back pain; Backache; Brain; Care and treatment; Case Report; Chronic pain; Congenital defects; Decompression; Drug resistance; Drug therapy; Electric stimulation; Epidural; Female; Humans; Implants, Artificial; Literature reviews; Local anesthesia; Magnetic resonance imaging; Medical equipment and supplies industry; Medical test kit industry; Neural tube defects; Neuralgia; Neuralgia - etiology; Neuralgia - therapy; Neuromodulation; Pain; Pain perception; Pain, Postoperative - etiology; Pain, Postoperative - therapy; Paresthesia-free; Patients; Pediatrics; Prosthesis; Questionnaires; Refractory pain; Scleroderma; Spinal cord; Spinal Cord Stimulation - methods; Syringomyelia; Syringomyelia - complications; Thorax; Treatment Outcome
• ISSN: 1471-2377; 1471-2377
• DOI: 10.1186/s12883-024-03789-8

Central neuropathic pain after foramen magnum decompression (FMD) for Chiari malformation type 1 (CM-1) with syringomyelia can be residual and refractory. Here we present a case of refractory central neuropathic pain after FMD in a CM-1 patient with syringomyelia who achieved improvements in pain following spinal cord stimulation (SCS) using fast-acting sub-perception therapy (FAST™). A 76-year-old woman presented with a history of several years of bilateral upper extremity and chest-back pain. CM-1 and syringomyelia were diagnosed. The pain proved drug resistant, so FMD was performed for pain relief. After FMD, magnetic resonance imaging showed shrinkage of the syrinx. Pain was relieved, but bilateral finger, upper arm and thoracic back pain flared-up 10 months later. Due to pharmacotherapy resistance, SCS was planned for the purpose of improving pain. A percutaneous trial of SCS showed no improvement of pain with conventional SCS alone or in combination with Contour™, but the combination of FAST™ and Contour™ did improve pain. Three years after FMD, percutaneous leads and an implantable pulse generator were implanted. The program was set to FAST™ and Contour™. After implantation, pain as assessed using the McGill Pain Questionnaire and visual analog scale was relieved even after reducing dosages of analgesic. No adverse events were encountered. Percutaneously implanted SCS using FAST™ may be effective for refractory pain after FMD for CM-1 with syringomyelia.