Case Studies
How the decision actually gets made
Chapters explain therapies in the abstract. These real cases show the reasoning: what the patient presented with, what had already failed, why one therapy was chosen over another, what the procedure involved, and what happened over time. Patient names are omitted from the written accounts.
About these cases
These are real cases and reported outcomes from the treating clinician, shared for education with patient authorization for the images. Patient names are omitted from the written accounts. The cases are not composites or fictional examples.
Each outcome describes that individual patient, not a typical result, prediction or promise. Results vary substantially between patients.
The Cases
Six presentations, six different answers
Notice how the therapy, anatomical target and treatment strategy change with each presentation — and that in one case, no permanent implant was used at all.
- 01
Abbott cervical SCS, lead tips at C2
Persistent cervical and radicular pain after multilevel anterior and posterior fusion
A 68-year-old woman with persistent neuropathic cervical pain and upper-extremity radicular symptoms after multilevel anterior cervical discectomy and fusion followed by posterior cervical fusion with instrumentation. Postoperative fibrosis and postsurgical changes contributed to an ongoing pain pattern despite prior treatment. An Abbott cervical spinal cord stimulator trial reduced the original symptom burden by approximately 85%, followed by permanent implantation with paired epidural leads extending to the C2 vertebral level. More than five years later, benefit remains approximately 85–90% with periodic programming optimisation.
- Patient
- 68-year-old woman
- Region
- Cervical and upper extremities
- Procedure
- Abbott cervical SCS, lead tips at C2
- Outcome
- 85–90% relief sustained beyond 5 years
- 02
Nalu PNS, superior medial and lateral genicular nerves
Medial-dominant neuropathic knee pain more than a decade after arthroscopy
An 82-year-old woman with debilitating right knee pain persisting for more than ten years after a minor arthroscopic procedure. The medial pain was substantially more severe than the lateral component, and the chronic neuropathic, CRPS-like pattern had resisted extensive conservative care. A five-day Nalu peripheral nerve stimulation trial targeting the superior medial and superior lateral genicular nerves reduced symptoms by approximately 80–85%. Following permanent implantation, improvement progressed to approximately 90% over four to six weeks and remained consistent through follow-up, allowing her to resume travel and activities with friends and family.
- Patient
- 82-year-old woman
- Region
- Right medial and lateral knee
- Procedure
- Nalu PNS, superior medial and lateral genicular nerves
- Outcome
- Approximately 90% sustained relief
- 03
Right L5 and S1 DRG stimulation
Complex regional pain syndrome confined to one foot
A patient in their forties with CRPS confined to the right foot after an L3–L5 lumbar fusion complicated by intraoperative injury to the right L5 and S1 nerves. Allodynia was so severe that a bedsheet was intolerable, and the neuropathic pain followed the L5 and S1 distributions. Following a previous SCS trial elsewhere that had failed to cover the foot, a successful two-lead DRG trial at right L5 and S1 led to permanent implantation at those same targets.
- Patient
- Mid 40s
- Region
- Right foot, L5 and S1 distribution
- Procedure
- Right L5 and S1 DRG stimulation
- Outcome
- Sustained at 12 months
- 04
60-day temporary PNS
Residual limb and phantom pain after below-knee amputation
A patient in their sixties with residual limb and phantom limb pain eleven months after a below-knee amputation. Treated with a temporary sixty-day peripheral nerve stimulation system targeting the sciatic and femoral nerves, removed entirely at the end of therapy.
- Patient
- Early 60s
- Region
- Left residual limb, phantom foot
- Procedure
- 60-day temporary PNS
- Outcome
- Benefit retained at 12 months
- 05
Restorative neurostimulation, L2 medial branch
Mechanical low back pain in a patient who was never a surgical candidate
A patient in their forties with a decade of mechanical low back pain, no prior spine surgery, no radicular symptoms, and imaging showing only degenerative change. Multifidus dysfunction on examination and imaging. Treated with restorative neurostimulation.
- Patient
- Late 40s
- Region
- Axial lumbar only
- Procedure
- Restorative neurostimulation, L2 medial branch
- Outcome
- Progressive gain over 24 months
- 06
10 kHz SCS, T8–T10 leads
Axial back pain persisting four years after lumbar fusion
A patient in their late fifties with predominantly axial low back pain four years after an L4–S1 fusion. Hardware intact, fusion solid, no recurrent stenosis. Two years of medication, injections and physical therapy without durable benefit. Treated with a 10 kHz spinal cord stimulator following a successful seven-day trial.
- Patient
- Late 50s
- Region
- Axial lumbar, bilateral buttock
- Procedure
- 10 kHz SCS, T8–T10 leads
- Outcome
- Sustained at 18 months
Does one of these sound like your situation?
No case describes you exactly. Read how candidacy is assessed, then discuss your own history and imaging with a clinician.