Sacral Nerve Stimulation for Treatment of Intractable Pain Associated with Cauda Equina Syndrome
Sacral nerve stimulation (SNS) is an effective treatment for bladder and bowel dysfunction, and also has a role in the treatment of chronic pelvic pain. We report two cases of intractable pain associated with cauda equina syndrome (CES) that were treated successfully by SNS. The first patient suffered from intractable pelvic pain with urinary incontinence and fecal incontinence after surgery for a herniated lumbar disc. The second patient underwent surgery for treatment of a burst fracture and developed intractable pelvic area pain, right leg pain, excessive urinary frequency, urinary incontinence, voiding difficulty and constipation one year after surgery. A SNS trial was performed on both patients. Both patients' pain was significantly improved and urinary symptoms were much relieved. Neuromodulation of the sacral nerves is an effective treatment for idiopathic urinary frequency, urgency, and urge incontinence. Sacral neuromodulation has also been used to control various forms of pelvic pain. Although the mechanism of action of neuromodulation remains unexplained, numerous clinical success reports suggest that it is a therapy with efficacy and durability. From the results of our research, we believe that SNS can be a safe and effective option for the treatment of intractable pelvic pain with incomplete CES.
- Ahn UM, Ahn NU, Buchowski JM, Garrett ES, Sieber AN, Kostuik JP : Cauda equina syndrome secondary to lumbar disc herniation : a meta-analysis of surgical outcomes. Spine (Phila Pa 1976) 25 : 1515-1522, 2000
- Aho AJ, Auranen A, Pesonen K : Analysis of cauda equina symptoms in patients with lumbar disc prolapse. Preoperative and follow-up clinical and cystometric studies. Acta Chir Scand 135 : 413-420, 1969
- Alo KM, Holsheimer J : New trends in neuromodulation for the management of neuropathic pain. Neurosurgery 50 : 690-703; discussion 703-704, 2002
- Bernstein AJ, Peters KM : Expanding indications for neuromodulation. Urol Clin North Am 32 : 59-63, 2005
- Comiter CV : Sacral neuromodulation for the symptomatic treatment of refractory interstitial cystitis : a prospective study. J Urol 169 : 1369-1373, 2003
- Everaert K, Kerckhaert W, Caluwaerts H, Audenaert M, Vereecke H, De Cuypere G, et al. : A prospective randomized trial comparing the 1-stage with the 2-stage implantation of a pulse generator in patients with pelvic floor dysfunction selected for sacral nerve stimulation. Eur Urol 45 : 649-654, 2004
- Floman Y, Wiesel SW, Rothman RH : Cauda equina syndrome presenting as a herniated lumbar disk. Clin Orthop Relat Res : 234-237, 1980
- Ganio E, Masin A, Ratto C, Altomare DF, Ripetti V, Clerico G, et al. : Short-term sacral nerve stimulation for functional anorectal and urinary disturbances : results in 40 patients : evaluation of a new option for anorectal functional disorders. Dis Colon Rectum 44 : 1261-1267, 2001
- Gstaltner K, Rosen H, Hufgard J, Mark R, Schrei K : Sacral nerve stimulation as an option for the treatment of faecal incontinence in patients suffering from cauda equina syndrome. Spinal Cord 46 : 644-647, 2008
- Kostuik JP, Harrington I, Alexander D, Rand W, Evans D : Cauda equina syndrome and lumbar disc herniation. Bone Joint Surg Am 68 : 386-391, 1986
- Matzel KE, Lux P, Heuer S, Besendorfer M, Zhang W : Sacral nerve stimulation for faecal incontinence : long-term outcome. Colorectal Dis 11 : 636-641, 2009
- Mayer RD, Howard FM : Sacral nerve stimulation : neuromodulation for voiding dysfunction and pain. Neurotherapeutics 5 : 107-113, 2008
- Melzack R, Wall PD : Pain mechanisms : a new theory. Science 150 : 971-979, 1965
- Orendacova J, Cazkova D, Kafka J, Lukacova N, Marsala M, Sulla I, et al. : Cauda equina syndrome. Prog Neurobiol 64 : 613-637, 2001
- Siegel S, Paszkiewicz E, Kirkpatrick C, Hinkel B, Oleson K : Sacral nerve stimulation in patients with chronic intractable pelvic pain. J Urol 166 : 1742-1745, 2001
- Shapiro S : Cauda equina syndrome secondary to lumbar disc herniation. Neurosurgery 32 : 743-746; discussion 746-747, 1993
- Vastenholt JM, Snoek GJ, Buschman HP, van der Aa HE, Alleman ER, Ijzerman MJ : A 7-year follow-up of sacral anterior root stimulation for bladder control in patients with a spinal cord injury : quality of life and users' experiences. Spinal Cord 41 : 397-402, 2003
- Vignes JR, De Seze M, Dobremez E, Joseph PA, Guerin J : Sacral neuromodulation in lower urinary tract dysfunction. Adv Tech Stand Neurosurg 30 : 177-224, 2005
- Ripetti V, Caputo D, Ausania F, Esposito E, Bruni R, Arullani A : Sacral nerve neuromodulation improves physical, psychological and social quality of life in patients with fecal incontinence. Tech Coloproctol 6 : 147-152, 2002
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