Double spinal cord stimulators (SCS) with different types of stimulation implanted percutaneously – case report and literature review

INTRODUCTION: Spinal cord stimulation (SCS) has emerged as a prevalent therapy for chronic neuropathic pain and failed back surgery syndrome (FBSS) over the past three decades, offering various stimulation types differentiated primarily by frequency. CASE REPORT: A 51-year-old male patient in 2016 underwent lumbar discectomy – L4/L5 due to symptomatic discopathy, which resulted in pain relief; however, the symptoms returned. In 2021 a Stimwave high-frequency (HF) SCS was placed epidurally at Th8–Th10. The patient reported substantial improvement after stimulation, nevertheless, after two weeks there was sudden exacerbation of his symptoms, especially in the lumbar region. Despite multiple attempts at program change and confirmation of the electrode location, there was no improvement. The HF stimulator was not removed owing to the risk of complications and 20% relief of pain in the right lower limb. After two years he was qualified for the implantation of newer generation of stimulators – BurstDR™ stimulation. An epidural electrode was implanted at Th8–Th10, followed by the placement of a BurstDR™ pulse generator. Currently, the patient has two active electrodes, one with HF stimulation, the other with BurstDR™ stimulation. CONCLUSIONS: Our case report demonstrates that there is no need to abandon SCS after the first failed attempt and it is worth trying stimulation with a different modulation. Furthermore, according to our center’s experience, the therapeutic effects of HF stimulation are quickly depleted and only after using burst stimulation was the expected result achieved. The reasons for this phenomenon are unknown and should be further researched.