2023 FSA Podium and Poster Abstracts

P029: A CASE REPORT OF BRACHIAL PLEXUS INJURY TREATED BY SPINAL CORD STIMULATOR DEVICE.
Abuzar Baloach, DO; Christine Hunt, DO; Mayo Clinic

This case report discusses a 79-year-old male patient who suffered from chronic right upper extremity pain following multiple surgeries, including anterior cervical discectomy and fusion, ulnar release surgery, wrist fusion, and reverse total shoulder arthroplasty. The patient had a brachial plexus injury after reverse total shoulder arthroplasty, which led to chronic pain in the affected arm. Despite multiple interventions, including physical therapy, desensitization techniques, medical therapies, and surgical interventions, the patient continued to experience significant pain and limited functionality in the affected arm. After undergoing a High-Frequency 10 (HF10) spinal cord stimulation (SCS) trial, the patient experienced significant improvement and ultimately received an implantable device. The patient reported significant pain relief and increased arm functionality, with a reduction in medication usage.

The patient's chronic pain persisted despite medication, physical therapy, nerve release surgery, and nerve stimulation. However, SCS has been shown to be effective in treating chronic pain of various etiologies, including failed back surgery syndrome, complex regional pain syndrome, and peripheral neuropathy. The mechanism of action for SCS in treating chronic pain is not fully understood, but it is thought to involve the modulation of pain signals through the spinal cord.

The patient underwent a trial of HF10 SCS, which resulted in significant pain relief. Following successful completion of the trial, the patient underwent implantation of a Nevro SCS device, which has been shown to be effective in treating chronic pain. SCS is a relatively safe and effective treatment option for chronic pain and has been shown to have few complications when performed by experienced clinicians. However, there are some risks associated with the procedure, including infection, bleeding, and nerve damage. Patients should be carefully selected for SCS based on their medical history, physical examination, and response to a trial stimulation procedure.

In conclusion, correctly identifying the underlying cause of chronic pain and seeking appropriate treatment is crucial. In this case, the patient had been misdiagnosed initially, leading to ineffective treatments. HF10 SCS was effective in treating the patient's brachial plexus injury-related pain and improving his functionality. The patient received an implantable Nevro SCS device and continues to report significant improvement in his pain and functionality.