MERT AKBAŞ, Mehmet Arif YEĞİN, İrem ÖZDEMİR, Ethem GÖKSU, Mahmut AKYÜZ

Postlaminektomi sendromlu hastada epidural ve subkutan elektrodun kombine uygulanması

Spinal kord stimülasyonu kronik bel ağrılarında uygulanan bir nöromodülasyon yöntemidir. Epidural alana yerleştirilen elektrodlarla, spinal kordun dorsal kolonu stimüle edilir. Ekstremite ağrısı olup spinal kord stimulasyonu uygulanan ve bel ve gluteal bölgede yeterli yanıt alınamayan postlaminektomili hastamıza ilave olarak subkutanöz lead uyguladık. Altmış beş yaşındaki erkek hasta lomber disk hernisi nedeniyle operasyon geçirmiş. Operasyon sonrası ağrı şikayetleri olan hastaya fizik tedavi ve steroid enjeksiyonları uygulanmış ancak fayda görmemiş. Hastamız bel bölgesinden başlayıp sağ kalça ve bacağa yayılan ağrı şikayetiyle algoloji polikliniğimize başvurdu. Spinal kord stimulasyonuna rağmen sağ kalça ve bel bölgesinde ağrı şikayeti devam eden hastaya sağ kluneal sinir dağılım bölgesine oktad elektrod SUBQ olarak yerleştirildi. Hastanın şuan VAS skoru 1-2 olup, ağrıları %80'in üzerinde azalmıştır. L1-2 vertebra aralığından girilerek oktad elektrod T8-T10 arasına yerleştirilerek sağ ekstremitede parestezi sağlandı. Parestezi alınamayan sağ gluteal bölge için ağrılı alanın sınırları belirlendi. Orta noktadan bir hat vertikal olarak çizilerek oktad lead SUBQ olarak yerleştirildi. Tüm alanda parestezi alındı (pw 390-450 msec, f 10-30 hz). Spinal kord stimulasyonu uygulanması sonrası parestezi sağlanamayan ve ağrısı geçmeyen hastalarda SUBQ elektrod yerleştirilmesi alternatif bir yöntem olarak uygulanabilir.

Subcutaneous stimulation as additional therapy to spinal cord stimulation in a post-laminectomy syndrome patient

Spinal cord stimulation as treatment of chronic low back pain via neuromodulation has been frequently performed in recent years. The dorsal column is stimulated by an electrode placed at the epidural region. In the case presently described, subcutaneous lead was implanted in a patient with failed back syndrome after spinal cord stimulation was inadequate to treat back and gluteal pain. A 65-year-old male had undergone surgery to treat lumbar disc herniation, after which he received physical therapy and multiple steroid injections due to unrelieved pain. He was admitted to the pain clinic with pain radiating to right gluteal muscle and leg. Spinal cord stimulation was performed and, as pain was not relieved, subcutaneous lead was applied to the right cluneal nerve distribution. Following treatment, the patient scored 1-2 on visual analog scale. Pain had been reduced by over 80%. Octad electrode was placed between T8 and T10 vertebrae after Tuohy needle was introduced to intervertebral area between L1 and L2. Paresthesia occurred in the right extremity. Boundaries were determined by area of right gluteal region in which paresthesia did not occur. Octad electrode was placed subcutaneously after vertical line was drawn from center point. Paresthesia occurred throughout the region. Pulse wave was 390-450 msec; frequency was 10-30 Hz. Subcutaneous electrode replacement is effective additional therapy when pain is not relieved by spinal cord stimulation.

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