A Case Report on Spinal Cord Stimulation in an Atrophic Spinal Cord: What Exactly Are We Stimulating?

INTRODUCTION: We present a patient with paraplegia secondary to anterior spinal cord infarct below T6, with subsequent development of chronic low-back and bilateral lower-extremity neuropathic pain with an atrophic cord. In this patient with reduced spinal cord mass and modified neuroanatomy, spinal cord stimulation was surprisingly very effective. OBJECTIVES: The primary objective of this report is to describe a case in which a patient benefited from spinal cord stimulator therapy in a way that is not explained by the traditionally accepted mechanism of action. METHODS: A spinal cord stimulator was implanted with two 16-contact leads placed in series starting at the top of T6. RESULTS: He reported complete resolution of low-back pain and about 50% resolution of bilateral lower-extremity pain. CONCLUSION: Traditionally accepted mechanisms of action of dorsal column stimulation and suppression of wide-dynamic-range neurons are unlikely to explain the relief obtained in our patient with an atrophic spinal cord. No single consensus has been reached on the primary mechanism through which spinal cord stimulation renders its therapeutic effects. Spinal cord stimulator therapy is promising, and the future direction of its study is discussed.