Spinal Cord Stimulation in an Elderly Patient With Severe Scoliosis and Failed Back Surgery Syndrome: A Case for Reconsidering Anatomical Contraindications

Spinal cord stimulation (SCS) has demonstrated efficacy in treating intractable pain associated with failed back surgery syndrome (FBSS), though its success in patients with severe spinal deformities remains uncertain. This case report presents a 78-year-old female patient with FBSS, advanced lumbar scoliosis, and multiple prior spinal surgeries, who experienced severe, debilitating pain despite extensive conservative and pharmacological treatments. Imaging revealed significant degenerative changes, spinal subluxations, and multilevel stenosis. After a successful SCS trial with 70-80% pain relief and full restoration of activities of daily living (ADLs), a nonrechargeable SCS system (Vanta) was implanted. Despite anatomical challenges, optimized electrode placement and programming adjustments resulted in sustained pain reduction and functional improvement. This case illustrates the potential feasibility of SCS in the setting of complex spinal pathology and emphasizes the value of individualized treatment planning. While not broadly generalizable, it contributes to the growing body of evidence supporting carefully selected use of SCS in anatomically challenging patients.