Heeho Kim, MD
Resident Physician
Jefferson Moss-Magee Rehabilitation
Philadelphia, Pennsylvania, United States
Jasmeet Oberoi, MD
Director
Einstein Pain Management Center
Philadelphia, Pennsylvania, United States
Post-laminectomy syndrome
Case Description: A 75-year-old male with post-laminectomy syndrome of lumbar region(PLS), presented to the clinic for a spinal cord stimulator(SCS) reimplantation for continued back pain and ambulatory dysfunction. Of note, the patient had a previous SCS which was working optimally, but it had to be explanted about one year ago as he developed prostate cancer and needed radiotherapy(RT). At the time of explantation, a multidisciplinary discussion was held, and both radiation oncologist and oncologist recommended the removal of the SCS for the concern of damaging the device. After completion of radiation therapy, he requested reimplantation of SCS as he was experiencing increased back pain that significantly limited his walking ability. About one year after the SCS removal as well as prostate cancer remission, we successfully reimplanted SCS without complications. He reports about 50 to 60% pain improvement and increased walking distance.
Discussions: Guidelines regarding the safe delivery of radiation therapy with SCS do not exist yet. Recommendation from the manufacturer for pacemakers or implantable cardioverter-defibrillators is to avoid direct irradiation of the device as the implantable pulse generators could be potentially damaged by the ionizing radiation or electromagnetic interference generated from the linear accelerator. However, given that SCS market is expected to grow as the range of indication for SCS continues to expand, it is imperative that guideline exists regarding the safe delivery of RT to a patient with SCS. In the interim, we successfully reimplanted SCS and achieved a favorable outcome in terms of improved gait dysfunction and decreased pain level.
Conclusions: We were able to successfully reimplant SCS after the completion of RT. However, further dosimetry data regarding the radiation tolerance of SCS systems need to be investigated to help avoid any unnecessary explantation and reimplantation processes if feasible.
