Thoracolumbar spinal cord stimulation for refractory painful diabetic neuropathy: A case report with sustained 3-month relief

This case report describes the use of closed-loop spinal cord stimulation in a 67-year-old male with painful diabetic neuropathy that was unresponsive to multiple conservative treatments. The patient had an 18-year history of diabetes with severe bilateral lower extremity burning and electric pain, rated at 10 out of 10 on the visual analog scale. He failed to improve with high-dose gabapentinoids, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, topical agents, physical therapy, and other supportive strategies. A trial of closed-loop spinal cord stimulation was performed using the Saluda Evoke® system, with a notable reduction in pain from 10 to 2 on the visual analog scale. The patient then underwent permanent implantation with continued improvement at 1-month and 3-month follow-up. Functional ability, sleep quality, and medication burden improved significantly. This case supports the role of closed-loop neuromodulation in treating refractory painful diabetic neuropathy.