Shah Tejas, Khosla Ankur
Physical Medicine and Rehabilitation, Hospital of the University of Pennsylvania, Philadelphia, USA.
Pain Management, AK Pain, Spine & Neuropathy, Woodlands, USA.
Cureus. 2022 Nov 14;14(11):e31495. doi: 10.7759/cureus.31495. eCollection 2022 Nov.
Sacroiliac joint pain (SIJP) has been difficult to properly manage in the medical field. Patients are initially managed with medications and physical therapy but may require further interventions including intra-articular corticosteroid injections, radiofrequency ablation, and sacroiliac joint fusion. Although peripheral nerve stimulation (PNS) and peripheral field nerve stimulation (PFNS) have been used with varying success, subcutaneous spinal cord stimulation (SCS) has not yet been utilized. We present the case of a patient with bilateral SIJP who had successful resolution with the use of subcutaneously-implanted SCS electrode leads. A 74-year-old female patient with a history of lumbar stenosis status post epidural steroid injection and minimally invasive lumbar decompression presented with year-long chronic low back pain (LBP) with unsuccessful pain relief from medical management and physical therapy. On physical exam, pain elicited with tenderness over both sacroiliac joints with positive Patrick's and Gaenslen's test bilaterally. After successful pain relief from a diagnostic SI joint injection, the patient underwent an SCS trial. Trial SCS leads were placed epidurally at T7 and subcutaneously next to bilateral SI joints. Epidural stimulation provided no pain relief after three days. Stimulation was then changed to the subcutaneous leads, with subsequent 90% pain relief. The patient then underwent a permanent implant with subcutaneous lead placement without complications. She reported pain relief ongoing for two years. SIJP is a difficult condition to treat despite various modalities. Recent advances in neuromodulation have shown anecdotal success with PNS. SCS involves electrode leads placed in the epidural space to provide axial back and radicular pain coverage. In this case, however, SCS leads were placed subcutaneously with excellent pain relief. Our case showcases the successful use of subcutaneous-implanted SCS which can provide another viable minimally invasive treatment option in the management of this pain source.
骶髂关节疼痛（SIJP）在医学领域一直难以得到妥善管理。患者最初接受药物治疗和物理治疗，但可能需要进一步的干预措施，包括关节内注射皮质类固醇、射频消融和骶髂关节融合术。尽管外周神经刺激（PNS）和外周区域神经刺激（PFNS）的使用取得了不同程度的成功，但皮下脊髓刺激（SCS）尚未得到应用。我们报告一例双侧SIJP患者，通过使用皮下植入的SCS电极导线成功缓解了疼痛。一名74岁女性患者，有腰椎管狭窄病史，曾接受硬膜外类固醇注射和微创腰椎减压术，出现长达一年的慢性下腰痛（LBP），药物治疗和物理治疗均未能成功缓解疼痛。体格检查时，双侧骶髂关节压痛诱发疼痛，Patrick试验和Gaenslen试验均为阳性。在诊断性骶髂关节注射成功缓解疼痛后，患者接受了SCS试验。试验性SCS导线分别置于T7硬膜外和双侧骶髂关节旁皮下。三天后，硬膜外刺激未能缓解疼痛。随后改为皮下导线刺激，疼痛随后缓解了90%。患者随后接受了皮下导线永久植入，未出现并发症。她报告疼痛缓解持续了两年。尽管有多种治疗方式，SIJP仍是一种难以治疗的疾病。神经调节的最新进展表明，PNS取得了一些成功案例。SCS涉及将电极导线置于硬膜外间隙，以覆盖轴向背痛和神经根性疼痛。然而，在本病例中，SCS导线置于皮下，疼痛得到了极好的缓解。我们的病例展示了皮下植入SCS的成功应用，它可以为这种疼痛源的管理提供另一种可行的微创治疗选择。
