Impact of Evoked Compound Action Potential (ECAP)-Controlled Closed-Loop Spinal Cord Stimulation in Refractory Lumbar Radiculopathy: A Case Report

Lumbar radiculopathy is a common pain disorder characterized by radiating pain from the lower back into the lower extremities. Conventional treatment options are frequently employed; however, many patients experience limited or inadequate symptom relief. Evoked Compound Action Potential (ECAP)-controlled closed-loop spinal cord stimulation (SCS) has emerged as a neuromodulation strategy that utilizes real-time physiological feedback to optimize stimulation delivery. This case report describes the use of ECAP-controlled closed-loop SCS in a patient with refractory lumbar radiculopathy. A white male in his 40s presented with chronic, debilitating right-sided lumbar radiculopathy refractory to prior treatments, which was caused by irritation, compression, or inflammation of a spinal nerve root. At baseline, the patient reported a numeric rating scale (NRS) pain score of 7/10, including limited sleep duration (four hours), standing tolerance (10 minutes), and walking tolerance (five minutes). The patient underwent an ECAPs-assisted closed-loop SCS using a Saluda Medical spinal cord stimulator system with a single 12-electrode lead positioned at the top of the T7 vertebral level. During the trial period (over five days), approximately 24.2 million automated stimulation adjustments were performed, and device utilization was recorded at 100%. Following treatment, the patient reported a significant reduction in pain (NRS=1) and had marked improvement in sleep (6 hours), standing tolerance (four hours), and walking tolerance (one hour). This case demonstrates meaningful and sustained improvement in pain and functional outcomes following ECAP-controlled closed-loop SCS in a patient with refractory lumbar radiculopathy. While these findings are promising, results from a single case should be interpreted cautiously, and further studies are warranted, as clinical outcomes were assessed at the end of a five-day SCS trial period.