Spinal Cord Stimulation for Pain Relief in Central Myelopathic Pain After Spinal Cord Tumor Resection: Two Case Reports

Introduction: Central myelopathic pain following spinal cord tumor resection is difficult to manage, with limited success using traditional treatments. Spinal stimulation, including spinal cord stimulation (SCS) and dorsal root ganglion (DRG) stimulation, is an emerging approach for chronic neuropathic pain in these cases.

Methods: Two cases were reviewed: a 76-year-old woman with persistent neuropathic pain after T7T8 meningioma resection and a 51-year-old man with chronic pain following T7 ependymoma resection. Symptom assessment was made using the numerical verbal scale (NVS) and Oswestry Disability Index (ODI).

Results: In the first case, a 76-year-old woman with chronic back and lower limbs neuropathic pain (NeP) with past of two lumbar spine surgeries. NVS was 8/10 and ODI 70%. After 1 year of complains, made a first dorsal MRI, and was diagnosed with T7T8 meningioma. After tumor removal, improvement in strength and gait, with pain persisting at the same intensity. It was opted for SCS with a paddle lead in T7T8T9 levels, with DTM™ stimulation with immediate and complete pain relief. Six months post-implant, her pain remained fully resolved, with ODI reduced to 16%, and she no longer required pain medication, reporting high satisfaction with her outcome.

In the second case, a 51-year-old man with chronic pain (NVS 8–10/10, ODI 85%) after T7 ependymoma resection initially obtained partial pain relief with SCS, with residual severe perineal and anal pain. Subsequent DRG stimulation targeting L1 and S2 provided significant additional relief, reducing his pain levels to 0–2/10. His ODI improved to 50%, reflecting moderate functional gain, and he reported substantial satisfaction with combined therapy. Both cases underscore neuromodulation's effectiveness in achieving meaningful, lasting pain relief and functional improvement for complex central neuropathic pain after tumor resection.

Conclusion : These cases demonstrate the potential of spinal stimulation, including DTM™ and combined SCS-DRG approaches, to provide effective pain relief and functional improvement in complex post-tumor neuropathic pain. This case series suggests that neuromodulation can be a valuable therapeutic option for central myelopathic pain post-tumor resection, warranting further exploration.