We entered the epidural space at C7-T1 level using a paramedian approach. Decision was made to proceed with a cervical spinal cord stimulator trial. Medical management with a combination of an antidepressant, an anticonvulsant, a nonsteroidal anti-inflammatory medication, and an opioid failed to improve his pain. He was not interested in functional recovery and was only concerned about relieving the pain. On examination, he had no sensation or motor function below the deltoid. He described his pain as burning, stabbing, and sometime like an electric shock, starting at the shoulder and radiating to the arm and his five fingers, with an intensity of 7/10 on a numeric pain rating scale. He lost sensation and motor function below the deltoid in his right upper extremity, however his main debilitating problem was severe chronic pain. Magnetic resonance imaging (MRI) showed complete nerve root avulsion from C6 to T1. He suffered from multiple injuries including injury to his right brachial plexus. We report a case of significant improvement in pain from brachial plexus avulsion injury after implanting a cervical SCS.Ī 25-year-old male patient was involved in a motor vehicle accident 5 years ago. Cervical spinal cord stimulation (SCS) is one of the underutilized treatment modalities with several reports of good outcome. However, in most cases, the pain is resistant to medical treatment and has a high-recurrence rate after invasive procedures like dorsal root entry zone (DREZ) lesioning. The pain can be treated medically or with more invasive surgical procedures. Almost 80% of patients with brachial plexus avulsion develop chronic pain.
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