Ventral Column Spinal Cord Stimulation for Refractory Back and Leg Pain

Spinal cord stimulation is a promising and increasingly used treatment for numerous pain etiologies. However, spinal cord stimulation is inconsistently and incompletely effective for refractory chronic back and leg pain, leaving significant room for advancement. While there has been moderate improvement over the past decade, in general, only half of patients with spinal cord stimulation experience only 50% pain relief. An inadequate response to spinal cord stimulation may be attributed, in part, to stimulation of a suboptimal anatomical target. Spinal cord stimulation is primarily applied to the dorsal columns and the dorsal horn of the spinal cord. However, more recently, stimulation of the ventral columns, which carry anterolateral spinothalamic pain tracts, has been successfully applied in certain pain conditions. In this case series, we compared ventral column to dorsal column spinal cord stimulation in three individuals undergoing standard-of-care dorsal column spinal cord stimulation 1-wk trials for refractory back and leg pain, two of which have since progressed to chronic implantation. Each individual had equivalent or improved pain relief and function with stimulation through ventral column leads compared to dorsal column leads. This series highlights the possibility of targeting the ventral column for refractory back and leg pain and the importance of increasing our understanding of how spinal cord stimulation modulates pain transmission.