P021: HIGH FREQUENCY SPINAL CORD STIMULATOR THERAPY FOR UPPER EXTREMITY CRPS : A CASE REPORT
William Grubb, MD, Mina Morgan, DO, Supreet Grewal, MD; RWJMS/Rutgers
Introduction: High Frequency (HF) spinal cord stimulator(SCS) therapy is a newer application of epidural lead neuro modulation which is paresthesia free. It usually takes several days to become effective. In this example, a 49 yr. male was referred to our service for evaluation of persistent pain and intermittent RUE swelling following a work related crush injury. The patient had been diagnosed with CRPS of the RUE. Our initial evaluation supported the diagnosis and the patient received several stellate ganglion blocks with excellent clinical results of limited duration, lasting only I week following the procedure.
A percutaneous 5 day trial with high frequency (HF) 10,000 hertz epidural spinal cord stimulator (SCS) system was proposed, implemented and resulted in the clinical changes of reduced pain, increased function and resolution of the intermittent edema of the hand and forearm
The patient elected to proceed with a percutaneous approach to implanted epidural leads
Methods: The patient was consented and after induction of GA, placed prone on several pillows with the arms tucked to the side. The forehead was placed in the neutral position side to side and supported by soft foam in flexion. Vancomycin IV antibiotics were given and with sterile field and sterile process, the epidural high frequency leads were placed with fluoroscopy to overly the middle of the C2 vertebral body in the AP view. They were confirmed to be posterior in all lateral views. The impedances of the leads were noted to be appropriate prior to the anchoring, tunneling and attachment of the leads to a HF 10,000 hertz generator inserted in the right gluteal area. Figure 1 and 2 demonstrate the final positions of the leads. The patient returned the clinic for incision check and system activation 1 week following the procedure.
Results: At one week post activation, the patient stated there was a detectable increase in overall function of the limb with a greater than 50% reduction in the pain. In addition, the intermittent swelling had resolved after two weeks of HF therapy.
Discussion: We are presenting one of several applications of high frequency SCS for the for the treatment of CRPS. A previous report detailed the use of HF SCS in the lower extremity1 which resulted in similar clinical results to those of our patient. It has been demonstrated that the high frequency paresthesia free therapy has been safely applied in the treatment of refractory back pain although there is limited information on the use for use in CRPS2
Ref 1- Pain Physician 2017- 20(1) E177-E182
Ref 2- Pain Med 2015- 16(5) 934-942