Spinal cord stimulation for treatment of the pain associated with hereditary multiple osteochondromas

Abstract

Ravi G Mirpuri,1 Jereme Brammeier,2 Hamilton Chen,2 Frank PK Hsu,1,3 Vi K Chiu,4 Eric Y Chang1,2,5 1Department of Physical Medicine and Rehabilitaiton, 2Department of Anesthesiology and Perioperative Care, 3Department of Neurological Surgery, 4Department of Medicine, 5Reeve-Irvine Research Center for Spinal Cord Injury, University of California Irvine, Irvine, CA, USA Objective: Hereditary multiple osteochondromas (HMO) usually presents with neoplastic lesions throughout the skeletal system. These lesions frequently cause chronic pain and are conventionally treated with surgical resection and medication. In cases where conventional treatments have failed, spinal cord stimulation (SCS) could be considered as a potential option for pain relief. The objective of this case was to determine if SCS may have a role in treating pain secondary to neoplastic lesions from HMO. Case presentation: We report a 65-year-old female who previously received both surgical and pharmacological interventions for treating HMO neoplastic pain in the lumbar, pelvis, femur, and tibial regions. These interventions either failed to offer significant pain relief or caused excessive lethargy. A SCS trial was then offered with a dual 16-contact lead trial leading to 70%–80% improvement in pain from baseline and 85% reduction in oxycodone IR intake. This was followed by permanent implantation of two 2×8 contact paddle leads (T7–T8 and T9–T10 interspaces). After 8-week follow-up, settings were further optimized resulting in an additional 30% improvement in pain compared to last visit. At 6-month follow-up, the patient reported continued pain relief. Conclusion: This case demonstrates the first successful use of SCS to treat both HMO and nonmalignant neoplastic-related pain. The patient reported pain improvement from baseline, reduced pain medication requirements, and subjective improvement in quality of life. Additionally, this case demonstrates the potential advantage of trialing multiple painful areas with a 16-contact lead in order to avoid multiple trials and placement. Keywords: Exostoses, bone neoplasms/pathology, hereditary exostoses/multiple, back pain/therapy, pain management, spinal cord stimulation, treatment outcome, chronic pain, case reports