• Sanjeev Kumar, Andrew Khoury, and Sam Searcy.
• Department of Anesthesiology/Pain Medicine, University of Florida, Gainesville, Florida, U.S.A.
• Pain Pract. 2021 Mar 1; 21 (3): 348-352.

IntroductionWe 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.ObjectivesThe 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.MethodsA spinal cord stimulator was implanted with two 16-contact leads placed in series starting at the top of T6.ResultsHe reported complete resolution of low-back pain and about 50% resolution of bilateral lower-extremity pain.ConclusionTraditionally 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.© 2020 World Institute of Pain.

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