Failed cervical laminectomy/fusions are considered a difficult situation. Epidurals are difficult. and rhizotomies might fail. Usually a cervical spinal cord stimulator is considered impossible due to scarring. However, in this case. a cervical spinal cord stimulator was much easier placed than thought and cut pain 80% . In one of my cases, chronic infection was considered and treatment achieved 36+% improvement in pain.
Dahbour, Layth et al.
Management of post-cervical laminectomy fusion pain syndrome with a successful trial of spinal cord stimulation.”
Pain reports vol. 6,4 e981. 21 Dec. 2021,
- 48-year-old woman with a history of type 2 diabetes, nonalcoholic steatohepatitis, and fibromyalgia
- history of anterior cervical discectomy and fusion, posterior cervical fusion, and significant epidural fibrosis
- “Over several years, her pain was well-controlled with cervical epidurals, trigger point injections, and facet medial branch blocks. She was maintained pharmacologically on pregabalin (Lyrica, Pfizer), duloxetine (Cymbalta, Lilly), and cyclobenzaprine, with break-through oxycodone 5 mg twice a day. However, in 2017, she noted increased right upper extremity pain in a nondermatomal distribution with vasomotor and sudomotor changes, consistent with complex regional pain syndrome, and required repeat stellate ganglion blocks for pain control.”
- As things got worse, spinal stimulator implanted despite fears of fibrosis interfering: “we were pleasantly surprised by the relative ease of lead placement
- 80% relief
- elderly gentleman with repeated level fusions, and failed facet rhizotomies ended up with a 9.5/10 pain level. Pain clinic and neurosurgeon had nothing to offer.
- Fortunately, he had been on ketamine injections which was found valuable in chronic unremitting pains:
- multiple attempts to use opioids failed. marijuana was unsatisfactory.
- Suspected underlying chronic P. acne infection
Chronic Neck and Back Pain Might Be a Treatable Infection
- Started: Azithromycin 1 gm initially, 500 mg bid x 3 days then 500 mg every 3 days.
- within weeks he was down to 7/10
- some months later,when contacted, he said was having a bad day with 6/10
Comments – new options are coming up all the time so do not give up hope. A new helpful procedure I was just getting into was stellate and cervical nerve root hydrodissection which I will discuss in a separate blog note.