P038: HIGH FREQUENCY STIMULATOR THERAPY FOR PHANTOM LIMB WITH LOW FREQUENCY SALVAGE
Mina Morgan, DO, Neeraj Nanavati, MD, William Grubb, MD, DDS; Rutgers - Robert Wood Johnson
Introduction: High Frequency (HF10) Spinal cord stimulation therapy has been utilized successfully for Back and Lower back pain (1). However, more recent studies have showed significant efficacy in Neck and Upper Limb pain. We utilized HF10 in a patient with a traumatic left upper extremity amputation from a motor vehicle accident with phantom limb pain. She was trialed with a percutaneous seven-day trial in which she had greater than 80% relief of her pain as both leads were placed to C2. The patient then elected to proceed with a percutaneous approach to implanted epidural leads.
Methods: The patient was placed under general anesthesia in the prone position. All pressure points were supported, appropriate antibiotics administered, and sterile process was ensured. We utilized a T12 entrance and were able to place one midline lead to C3 vertebral body and one to C6 just to the right of midline. Ideally, both leads would be placed midline, however, due to positioning difficulties, we were unable to place them into C2 in same fashion as was trial. As a result, when she was getting programmed, we were unable to achieve the level of pain relief from prior trial. We had the patient repeat x-rays that are seen in figure 1 and 2. As a result, we decided that due to her left lead being lateral to midline that we can try to utilize low-frequency in combination with higher frequency. After reprogramming her with low frequency between 50-60hz as well as using the midline lead to utilize HF10, we could recapture some of the success seen on the trial.
Result: We spoke to the patient one week and two weeks post-reprogramming of the leads utilizing combination therapy with HF10 as well as low frequency we were able to achieve 50-60% reduction in pain. Patient states that she is extremely satisfied with the results and will begin to reduce usage of medications.
Discussion: High frequency SCS is being utilized for a larger variety of indications. HF10 has shown superiority for chronic back and leg pain and has been successfully utilized for upper limb pain. The ability for HF10 to utilize both low and high frequency allows for versatility and the ability to salvage in the instance of lead migration or loss of efficacy.