Cervical dorsal column stimulation for post-stroke neuropathic pain: Effects on lower limb pain

Abstract

   Some reports showed the beneficial effects of spinal cord stimulation (SCS) for centrl post–stroke pain (CPSP). However, the appropriate technique of SCS for CPSP, has not been established yet because of the complex pathological conditions of CPSP, which differ from those of other intractable pains. CPSP often involves both of the unilateral upper and lower limbs. Therefore, the appropriate electrode position is sometimes difficult to determine. We attempted to place the electrode in the cervical dorsal column and mainly studied the effects on the lower limb. Subjects were six CPSP patients followed up from 2 to 5 years. Their causal lesions of pain were the thalamus in five patients and the internal capsule in one patient. We implanted the two SCS electrodes in the cervical epidural space very close to the midline for the lower limb and the lateral side for upper limb. All of the patients felt paresthesia in the lower limb during the intraoperative test stimulation. All of them consented to the implantation of devices for chronic SCS after 1 week of extraoperative test stimulation. During the follow–up period, all but one patient were satisfied with the effects of SCS. The one patient who was not satisfied needed to undergo a re–operation for the lower limb pain. Cervical SCS could induce paresthesia in lower limb and might be a beneficial treatment measure for CPSP.