Spinal Cord Stimulation for Painful Neuropathic Cauda Equina Syndrome Following Ballistic Penetrating Lumbar Spine Injury: Proof-of-Concept Case

Modern warfare, as well as the rise of terrorist attacks on the mainland France, make military personnel deployed overseas but also civilians more prone to sustain wartime penetrating injury, the spine being involved in 6%-8% of the cases. In the long-term, some of these casualties may suffer from neuropathic pain of the lower limbs refractory to medical treatment. Thoracic spinal cord stimulation is a possible surgical treatment option for chronic neuropathic pain of the limbs caused by diabetic neuropathy, type 2 persistent spinal pain syndrome after back surgery, and complex regional pain syndrome. We report the case of a 58-year-old civilian who was operated on 2 times for a penetrating spine injury at L2 level, and later developed painful neuropathic cauda equina syndrome. He was referred to the pain specialist 12 years later but medical treatment was insufficient. Eventually, the patient was operated on with lower thoracic spinal cord stimulation. After 18 months of follow-up, the patient self-reported significant pain relief as witnessed by a reduction of the Oswestry Disability Index (ODI) questionnaire from 56% to 28%, and a reduction of the pain from 8 to 5/10 on the Visual Analogue Scale (VAS) for pain. This case opens the door to a reasonably invasive surgical treatment option for military and civilians patients suffering from intractable neuropathic pain of the lower limbs after penetrating spine injury.