Spinal cord stimulation for chronic pain treatment following sacral chordoma resection: illustrative case

Khaled M Taghlabi Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas; and
Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, Texas

Search for other papers by Khaled M Taghlabi in
Current site
jns
Google Scholar
PubMed
Close
 MD
,
Taimur Hassan Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas; and
Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, Texas

Search for other papers by Taimur Hassan in
Current site
jns
Google Scholar
PubMed
Close
 MPH, MBA
,
Isuru A Somawardana Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas; and
Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, Texas

Search for other papers by Isuru A Somawardana in
Current site
jns
Google Scholar
PubMed
Close
 BS
,
Sibi Rajendran Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas; and
Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, Texas

Search for other papers by Sibi Rajendran in
Current site
jns
Google Scholar
PubMed
Close
 MD
,
Ahmed Doomi Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas; and

Search for other papers by Ahmed Doomi in
Current site
jns
Google Scholar
PubMed
Close
 MD
,
Lokeshwar S Bhenderu Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas; and
Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, Texas

Search for other papers by Lokeshwar S Bhenderu in
Current site
jns
Google Scholar
PubMed
Close
 BS
,
Jesus G Cruz-Garza Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas; and
Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, Texas

Search for other papers by Jesus G Cruz-Garza in
Current site
jns
Google Scholar
PubMed
Close
 PhD
, and
Amir H Faraji Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas; and
Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, Texas

Search for other papers by Amir H Faraji in
Current site
jns
Google Scholar
PubMed
Close
 MD, PhD
Open access

BACKGROUND

Cancer-related or postoperative pain can occur following sacral chordoma resection. Despite a lack of current recommendations for cancer pain treatment, spinal cord stimulation (SCS) has demonstrated effectiveness in addressing cancer-related pain.

OBSERVATIONS

A 76-year-old female with a sacral chordoma underwent anterior osteotomies and partial en bloc sacrectomy. She subsequently presented with chronic pain affecting both buttocks and posterior thighs and legs, significantly impeding her daily activities. She underwent a staged epidural SCS paddle trial and permanent system placement using intraoperative neuromonitoring. The utilization of percutaneous leads was not viable because of her history of spinal fluid leakage, multiple lumbosacral surgeries, and previous complex plastic surgery closure. The patient reported a 62.5% improvement in her lower-extremity pain per the modified Quadruple Visual Analog Scale and a 50% improvement in the modified Pain and Sleep Questionnaire 3-item index during the SCS trial. Following permanent SCS system placement and removal of her externalized lead extenders, she had an uncomplicated postoperative course and reported notable improvements in her pain symptoms.

LESSONS

This case provides a compelling illustration of the successful treatment of chronic pain using SCS following radical sacral chordoma resection. Surgeons may consider this treatment approach in patients presenting with refractory pain following spinal tumor resection.

ABBREVIATIONS

EMG = electromyography; mPSQ-3 = modified Pain and Sleep Questionnaire 3-item index; mQVAS = modified Quadruple Visual Analog Scale; NRS = numeric rating scale; ODI = Oswestry Disability Index; SCS = spinal cord stimulation; SSEP = somatosensory evoked potential; VAS = visual analog scale

BACKGROUND

Cancer-related or postoperative pain can occur following sacral chordoma resection. Despite a lack of current recommendations for cancer pain treatment, spinal cord stimulation (SCS) has demonstrated effectiveness in addressing cancer-related pain.

OBSERVATIONS

A 76-year-old female with a sacral chordoma underwent anterior osteotomies and partial en bloc sacrectomy. She subsequently presented with chronic pain affecting both buttocks and posterior thighs and legs, significantly impeding her daily activities. She underwent a staged epidural SCS paddle trial and permanent system placement using intraoperative neuromonitoring. The utilization of percutaneous leads was not viable because of her history of spinal fluid leakage, multiple lumbosacral surgeries, and previous complex plastic surgery closure. The patient reported a 62.5% improvement in her lower-extremity pain per the modified Quadruple Visual Analog Scale and a 50% improvement in the modified Pain and Sleep Questionnaire 3-item index during the SCS trial. Following permanent SCS system placement and removal of her externalized lead extenders, she had an uncomplicated postoperative course and reported notable improvements in her pain symptoms.

LESSONS

This case provides a compelling illustration of the successful treatment of chronic pain using SCS following radical sacral chordoma resection. Surgeons may consider this treatment approach in patients presenting with refractory pain following spinal tumor resection.

ABBREVIATIONS

EMG = electromyography; mPSQ-3 = modified Pain and Sleep Questionnaire 3-item index; mQVAS = modified Quadruple Visual Analog Scale; NRS = numeric rating scale; ODI = Oswestry Disability Index; SCS = spinal cord stimulation; SSEP = somatosensory evoked potential; VAS = visual analog scale

Chordoma is a malignant tumor arising from remnants of the notochord, a structure present during early fetal development.1,2 These tumors typically grow slowly, albeit aggressively, in the axial skeleton and comprise 1%–4% of all primary bone tumors, with the sacral chordoma the most common primary malignant tumor in the sacrum.3 Sacral chordomas are nonetheless rare, with an estimated incidence of 1 case per 1 million individuals annually.2,4–6 They typically affect adults, with a peak incidence between the ages of 40 and 60 years.2,6

The clinical presentation of sacral chordoma is dependent on the lesion’s location and size. Initially, patients can be asymptomatic or experience nonspecific symptoms.2,7 As the tumor grows, it can compress adjacent structures, leading to symptoms such as lower back pain, sciatica, numbness or weakness in the lower extremities, and bowel or bladder dysfunction.2,7 The insidious onset and mild symptoms of sacral chordoma often lead to late diagnosis and poor prognosis, as most patients are diagnosed at an advanced stage.4,5,8 Because of its location near vital neurovascular structures in the sacrum and pelvis, treating sacral chordoma presents a challenge to surgeons.9 While chemotherapy and radiation are often less effective against chordomas, the primary treatment approach is wide excision.10

Following sacral chordoma resection, some patients can experience chronic and severe pain that is refractory to conventional pain-management approaches.11 In cases of refractory cancer-related pain, spinal cord stimulation (SCS) has emerged as a promising method to alleviate pain and improve the quality of life in these individuals.12 SCS is a procedure in which electrodes are placed epidurally above the spinal cord to manage pain.13 These electrodes emit pulses that can potentially alleviate pain.13

Spinal cord stimulation is particularly valuable for cancer-related pain, as it offers a nonpharmacological alternative to opioids and other analgesics that can have adverse side effects and limited efficacy in managing severe and chronic pain.12,14,15 Additionally, SCS is effective in treating various chronic pain conditions, including neuropathic pain. As with any emerging approach, medical professionals must continue to research and share clinical experiences to refine operative techniques and improve patient outcomes.16 Herein, we discuss the case of a recurrent sacral chordoma that was treated with sacral osteotomies and partial en bloc sacrectomy, with subsequent chronic pain affecting both buttocks and posterior thighs and legs, which was successfully managed with an SCS system, resulting in substantial pain relief.

Illustrative Case

A 76-year-old female underwent resection of a recurrent sacral chordoma (Fig. 1) via an anterior approach for anterior sacral osteotomies, followed by a posterior approach for partial en bloc sacrectomy 6 months before her current presentation with ongoing bilateral buttock and posterior thigh and leg pain. The patient described her pain as paraspinal dull, aching, and burning pain with occasional electric shock–like pain experienced on the right and occasionally on the left side limiting her ability to perform activities of daily living, including sitting, walking, or standing. Of note, the patient had undergone positron emission tomography scanning before the chordoma resection, which showed a rounded soft tissue density at the posterior aspect of the sacral surgical bed with mild uptake and innumerable new, small, bilateral pulmonary nodules suspicious for metastasis. Further investigation with chest computed tomography confirmed the numerous small lung metastatic lesions. Following the uncomplicated resection of the sacral chordoma, the patient underwent adjuvant radiation therapy to the surgical bed.

FIG. 1
FIG. 1

Sagittal (A) and axial (B) T2-weighted magnetic resonance images demonstrating the size and extent of the sacral chordoma. The blue arrow represents the sacral chordoma tumor.

On neurological examination, the patient was alert, attentive, and oriented. She had a cachectic appearance. She had diffuse weakness with approximately 4/5 strength in all muscle groups. She had bilateral lower-limb pain starting in her buttocks and extending to both legs; however, light-touch sense was grossly intact throughout. Her gait was antalgic and stooped. As her neuropsychological evaluation was satisfactory, the patient was deemed a candidate for the SCS trial. Because of her multiple previous spinal and pelvic surgeries, with expected scarring of the tissues along the lumbosacral spine, a paddle electrode trial was elected rather than a percutaneous electrode trial approach. The feasibility and safety of an intrathecal drug pump procedure were significantly compromised due to a complex plastic surgery closure over the lumbar spine.

For the trial placement, the patient was placed under general endotracheal intravenous anesthesia with intraoperative neuromonitoring of somatosensory evoked potentials (SSEPs) and electromyography (EMG) in the target muscles of her lower extremities. A small midline incision with an interlaminar approach and limited bilateral T9 laminectomy with resection of the ligamentum flavum was performed for exposure of the epidural space. The paddle lead was advanced rostrally in the epidural space and was placed in the functional midline of the spinal cord spanning the bottom of the T7 vertebra through T9 (Fig. 2) to accommodate the patient’s specific back and lower-extremity pain.

FIG. 2
FIG. 2

Anteroposterior chest radiograph demonstrating the SCS system implanted at the lower vertebral level of T7 through T9. The blue arrow represents the spinal cord stimulator system implanted over the vertebrae.

Intraoperative stimulation testing was performed through the paddle with monitoring of SSEPs and EMG activity, confirming correct placement of the electrode. The anatomical placement on fluoroscopy appeared in the midline, especially at the T8–9 levels. The top portion of the paddle near T7 was slightly toward the right based on fluoroscopy because of her scoliosis; however, stimulation at the upper contacts also resulted in bilateral findings on collision testing of SSEPs, indicative of her true physiological midline, as shown in Fig. 1. The lead extenders were externalized and secured to the skin. After standard layered closure and recovery, she was discharged home for the week-long trial period.

A modified Quadruple Visual Analog Scale (mQVAS) and a modified Pain and Sleep Questionnaire 3-item index (mPSQ-3) were used to assess pre- and postoperative pain. While the original QVAS and PSQ-3 scores are calculated using length measurements for every question, we resorted to an mQVAS and mPSQ-3 survey with discrete numbers on a scale of 0 to 10 (0, no pain; 10, worst possible pain). The sum of questions was calculated and multiplied by 10 to output the mQVAS and mPSQ-3 scores preoperatively and postoperatively. A lower-extremity pain mQVAS score of 320 preoperatively was reduced to 120 after SCS system implantation, a 62.5% improvement. There was a 50% improvement in the mPSQ-3 score after SCS implantation (30 vs 15). The patient’s disability was assessed pre- and postoperatively using the Oswestry Disability Index (ODI). The preoperative ODI of 86% was reduced to 62% after SCS, a 28% improvement.

Ultimately, the patient had a dramatic response during the SCS trial. She had marked improvement in her pain, an improved activity level, and an improved quality of life during the trial period. Thus, the patient was believed to be a good candidate for permanent SCS system implantation. One week later, the patient underwent permanent placement of an implantable pulse generator (WaveWriter Alpha Prime, Boston Scientific) and connection to her existing paddle leads with disconnection and removal of the lead extenders. The patient’s SCS system was programmed to her trial settings, and she was taken to the recovery room without any complications and was subsequently discharged home.

At her postoperative visit, the patient was doing very well. She has not noticed any new issues since her surgery and endorsed continued improvement in her symptoms. She underwent complex programming of the SCS system in the clinic with satisfactory results and target area coverage. At 1 month postoperatively, she had a brief 1-day hospitalization for coronavirus disease 2019 (COVID-19) infection, which was treated without complication. At a 2-month oncology follow-up, she showed progression of metastatic disease but maintained back and lower-extremity pain relief.

Patient Informed Consent

The necessary patient informed consent was obtained in this study.

Discussion

Spinal cord stimulation has predominantly been used in neuromodulation for pain17 and, more recently, following cancer resection. Surgery remains the mainstay treatment for sacral chordomas. Bowel, bladder, and sexual dysfunction can be common, depending on the level of resection. Sacral nerve stimulation has been previously used in the treatment of these comorbidities, specifically nonobstructive urinary retention after partial sacral resection.18 In a subset of patients, conservative approaches, such as medications, fail to treat refractory pain. As a result, neuromodulation with SCS represents an innovative application for a potential new indication.19

Intraoperative direct stimulation can be used to map sensory tracts around the brainstem. In the spinal cord, electrophysiological studies have demonstrated that there is an attenuation of nociceptive reflexes with SCS, as well as an alteration of sympathetic reflexes, a reduction in H-reflex, and a reduction in a component of SSEP signals.20–22 It is thought that SCS causes widespread inhibition of sensory afferent inputs, leading to its apparent analgesic effect. Nonetheless, more studies are required to understand the relationship between this reflex reduction and pain relief.22

There is a paucity of evidence in the literature regarding postoperative morbidity and complication rates following sacral chordoma resection. A retrospective case series of 50 patients who had undergone en bloc resection of sacral chordoma demonstrated an overall complication rate of 62%, of which 42% were major complications and 26% required reoperation.11 The most common complications included neuropathic pain, wound infection, and urinary tract infections. Of the 10 patients (20%) who developed neuropathic pain after surgery, 8 received medications to manage the pain. Of the remaining 2, 1 patient underwent SCS system implantation (Table 1) and another received an intrathecal opioid pump to treat the more severe and intractable pain. A second study consisted of 21 patients who all underwent wide resection via a posterior approach in the treatment of chordoma. Neuropathic pain was observed in 8 patients (38%), all reporting pain between 9 and 10 on a numeric rating scale (NRS). The types of pain varied among the patients, with 7 reporting burning pain, 4 reporting electric shock–like pain, 2 reporting tingling pain, and 1 reporting itching pain.23

TABLE 1

Literature review of SCS for lumbosacral cancer–related pain

Authors & YearNo. of Participants w/ SCSTumor TypeSCS System BrandIndicationOutcome
Tsubota et al., 2009251 Metastasis of renal cell carcinoma to sacrumUnknownNeuropathic painSuccessful pain relief until death, 6 mos after implantation
Yakovlev & Resch, 20122615 Metastatic disease related to colon, anal cancer, or angiosarcoma of sacrumRestorePRIME nonrechargeable or RestoreULTRA (Medtronic)Intractable chronic low-back painAt 12-mo FU visit, all patients reported significant pain relief (>50% reduction in VAS score)
Mosiewicz et al., 2017271 Lumbosacral intradural tumor (schwannoma)Prime-Advanced equipped w/ 16-contact electrode (Medtronic)Neuropathic painSuccessful treatment, VAS score decreased from 6 to 1; ODI decreased from 40% to 20%; SF-MPQ score decreased from 40 to 20
Draper et al., 2017281 Sacral chordoma5-lead paddle electrode from St. JudeRefractory lower back & lower-extremity pain>50% improvement in lower back & lower-extremity pain; decreased opioid analgesic use; adequate pain control from SCS at 12-mo FU
Yakovlev & Ellias, 2018291 Metastatic epidural tumor in low thoracic spine from carcinoma of colonSynergy generator (Medtronic)Postop neuropathic pain90%–100% pain relief; stopped using opioids; increased levels of functioning & sleep; 12 mos postimplant, sustained pain relief & continued improvement in functioning
Zuckerman et al., 2021111 Sacral chordomaUnknownPostop neuropathic painUnknown

FU = follow-up; SF-MPQ = short-form McGill Pain Questionnaire.

With regard to sacral chordoma resection, neuropathic pain is a common complication due to potential nerve damage or irritation during surgery.23 The use of SCS can be considered for patients who do not obtain sufficient pain relief from conventional measures alone or those who want to avoid the associated symptoms of opioid pain medications, such as lethargy and sedation.

Observations

Previous studies have investigated the effectiveness and safety of SCS for cancer-related pain. In a systematic review that compared the efficacy of SCS with conventional analgesic medication for cancer-related pain, 4 before-and-after case-series studies, involving 92 participants, were included.15 The visual analog scale (VAS) was used to assess pain relief. By the end of the follow-up period in 2 trials, 76% of patients reported pain relief. In the third trial, the mean preoperative VAS scores improved by approximately 60% at 1 month after SCS system implantation (7.43 vs 3.07) and by 64% at 12 months postimplantation (7.43 vs 2.67). These findings were similar to those reported following the fourth trial, in which VAS scores improved by 62% at 1 month (7.07 vs 2.67) versus 74% at 12 months postimplantation (7.07 vs 1.87). Similarly, in our case, mQVAS scores improved by 62.5% following SCS system implantation (320 vs 120), a number consistent with rates reported in the literature.

A recent single-center retrospective case series evaluated exceptional cases of refractory cancer-related pain treated with SCS at a tertiary cancer center.12 Clinical assessment of postoperative pain was done using the NRS.24 The average change in NRS score after SCS system implantation was –3. At 2 weeks postimplantation, the average change in the NRS score and daily oral morphine equivalents were –2 and –126 mg, respectively; at 2 months postimplantation, the values were –3 and –96 mg, respectively. Additionally, the authors reported that 6 patients were discharged within 2 days after surgery and 2 patients required readmission for pain control during their follow-up period.12 Similarly, our patient endorsed significant improvement in her pain severity following SCS to the extent that she no longer needed any analgesic agents. She was discharged on the same day after surgery, and she did not require any readmission for pain control or any further complications.

Lessons

While SCS has recently emerged as a promising approach to the treatment of intractable neuropathic pain, several limitations warrant attention before its widespread adoption. First, the effectiveness of SCS in alleviating pain can vary among patients, and the placement of trial electrodes to gauge this effectiveness is still an invasive surgery. Similarly, the implantation of SCS carries inherent risks, such as infection and bleeding. In addition, the long-term use of SCS may lead to tolerance and life-long dependence on the system for a pain-free lifestyle. With these limitations in mind, a comprehensive approach that considers patient selection, counseling, and pain etiology is paramount for optimizing the benefits of SCS in managing neuropathic or chronic pain following surgical treatment.

In conclusion, we present a compelling case demonstrating the successful treatment of cancer-related pain through SCS following chordoma resection. The positive outcomes observed in this patient suggest that SCS could be a valuable and promising approach for managing refractory pain in individuals who have undergone spinal tumor resection. By offering an adjunct or alternative method for pain management, SCS presents a nonpharmacological and customizable solution, potentially enhancing the quality of life of patients with persistent pain.

Author Contributions

Conception and design: Faraji, Taghlabi, Hassan. Acquisition of data: Faraji, Taghlabi, Hassan, Somawardana. Analysis and interpretation of data: Faraji, Taghlabi, Hassan, Somawardana, Cruz-Garza. Drafting of the article: Faraji, Taghlabi, Hassan, Somawardana, Bhenderu. Critically revising the article: all authors. Reviewed submitted version of the manuscript: Faraji, Taghlabi, Somawardana, Rajendran, Doomi, Bhenderu, Cruz-Garza. Approved the final version of the manuscript on behalf of all authors: Faraji. Statistical analysis: Taghlabi, Somawardana, Cruz-Garza. Administrative/technical/material support: Faraji, Taghlabi, Rajendran. Study supervision: Faraji, Taghlabi, Cruz-Garza.

References

  • 1

    Sciubba DM, Chi JH, Rhines LD, Gokaslan ZL. Chordoma of the spinal column. Neurosurg Clin N Am. 2008;19(1):515.

  • 2

    Pillai S, Govender S. Sacral chordoma: a review of literature. J Orthop. 2018;15(2):679684.

  • 3

    Kayani B, Hanna SA, Sewell MD, Saifuddin A, Molloy S, Briggs TW. A review of the surgical management of sacral chordoma. Eur J Surg Oncol. 2014;40(11):14121420.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    McMaster ML, Goldstein AM, Bromley CM, Ishibe N, Parry DM. Chordoma: incidence and survival patterns in the United States, 1973-1995. Cancer Causes Control. 2001;12(1):111.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Chugh R, Tawbi H, Lucas DR, Biermann JS, Schuetze SM, Baker LH. Chordoma: the nonsarcoma primary bone tumor. Oncologist. 2007;12(11):13441350.

  • 6

    Scampa M, Tessitore E, Dominguez DE, et al. Sacral chordoma: a population-based analysis of epidemiology and survival outcomes. Anticancer Res. 2022;42(2):929937.

  • 7

    Soo MY. Chordoma: review of clinicoradiological features and factors affecting survival. Australas Radiol. 2001;45(4):427434.

  • 8

    Gokaslan ZL, Zadnik PL, Sciubba DM, et al. Mobile spine chordoma: results of 166 patients from the AOSpine Knowledge Forum Tumor database. J Neurosurg Spine. 2016;24(4):644651.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Yang Y, Li Y, Liu W, Xu H, Niu X. The clinical outcome of recurrent sacral chordoma with further surgical treatment. Medicine (Baltimore). 2018;97(52):e13730.

  • 10

    Fourney DR, Gokaslan ZL. Current management of sacral chordoma. Neurosurg Focus. 2003;15(2):E9.

  • 11

    Zuckerman SL, Lee SH, Chang GJ, et al. Outcomes of surgery for sacral chordoma and impact of complications: a report of 50 consecutive patients with long-term follow-up. Global Spine J. 2021;11(5):740750.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Bulat E, Chakravarthy V, Crowther J, Rakesh N, Barzilai O, Gulati A. Exceptional cases of spinal cord stimulation for the treatment of refractory cancer-related pain. Neuromodulation. 2023;26(5):10511058.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Traeger AC, Gilbert SE, Harris IA, Maher CG. Spinal cord stimulation for low back pain. Cochrane Database Syst Rev. 2023;3(3):CD014789.

  • 14

    Peng L, Min S, Zejun Z, Wei K, Bennett MI. Spinal cord stimulation for cancer-related pain in adults. Cochrane Database Syst Rev. 2015(6):CD009389.

  • 15

    Lihua P, Su M, Zejun Z, Ke W. Spinal cord stimulation for cancer-related pain in adults. Cochrane Database Syst Rev. 2013(2):CD009389.

  • 16

    Hagedorn JM, Pittelkow TP, Hunt CL, D’Souza RS, Lamer TJ. Current perspectives on spinal cord stimulation for the treatment of cancer pain. J Pain Res. 2020;13:32953305.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Ferraro MC, Gibson W, Rice ASC, Vase L, Coyle D, O’Connell NE. Spinal cord stimulation for chronic pain. Lancet Neurol. 2022;21(5):405.

  • 18

    Noblett KL, Cadish LA. Sacral nerve stimulation for the treatment of refractory voiding and bowel dysfunction. Am J Obstet Gynecol. 2014;210(2):99106.

  • 19

    Cunningham KG, Westney OL. Sacral neuromodulation for the treatment of retention in partial sacrectomy patients. Neuromodulation. 2016;19(8):897900.

  • 20

    García-Larrea L, Peyron R, Mertens P, et al. Electrical stimulation of motor cortex for pain control: a combined PET-scan and electrophysiological study. Pain. 1999;83(2):259273.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    de Andrade DC, Bendib B, Hattou M, Keravel Y, Nguyen JP, Lefaucheur JP. Neurophysiological assessment of spinal cord stimulation in failed back surgery syndrome. Pain. 2010;150(3):485491.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Wolter T, Kieselbach K, Sircar R, Gierthmuehlen M. Spinal cord stimulation inhibits cortical somatosensory evoked potentials significantly stronger than transcutaneous electrical nerve stimulation. Pain Physician. 2013;16(4):405414.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Phimolsarnti R, Waikakul S. Prevalence of neuropathic pain after radical sacral chordoma resection: an observational cohort study with 10-year follow-up. Eur J Orthop Surg Traumatol. 2015;25(suppl 1):S225S231.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005;14(7):798804.

  • 25

    Tsubota S, Higaki N, Nagaro T. A case of neuropathic cancer pain in the lower extremities successfully treated with spinal cord stimulation. Article in Japanese. Masui. 2009;58(11):14601461.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Yakovlev AE, Resch BE. Spinal cord stimulation for cancer-related low back pain. Am J Hosp Palliat Care. 2012;29(2):9397.

  • 27

    Mosiewicz A, Kamieniak P, Mosiewicz-Madejska B, Kaczmarczyk R, Rudzki M, Trojanowski T. Successful spinal cord stimulation for neuropathic pain after subtotal resection of the lumbosacral neurinoma.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Draper LMTW, Kurtom KH. Spinal cord stimulation for pain relief of unresectable sacral chordoma: case report. J Spine Neurosurg. 2017;6:3.

  • 29

    Yakovlev AE, Ellias Y. Spinal cord stimulation as a treatment option for intractable neuropathic cancer pain. Clin Med Res. 2008;6(3–4):103106.

  • Collapse
  • Expand
  • FIG. 1

    Sagittal (A) and axial (B) T2-weighted magnetic resonance images demonstrating the size and extent of the sacral chordoma. The blue arrow represents the sacral chordoma tumor.

  • FIG. 2

    Anteroposterior chest radiograph demonstrating the SCS system implanted at the lower vertebral level of T7 through T9. The blue arrow represents the spinal cord stimulator system implanted over the vertebrae.

  • 1

    Sciubba DM, Chi JH, Rhines LD, Gokaslan ZL. Chordoma of the spinal column. Neurosurg Clin N Am. 2008;19(1):515.

  • 2

    Pillai S, Govender S. Sacral chordoma: a review of literature. J Orthop. 2018;15(2):679684.

  • 3

    Kayani B, Hanna SA, Sewell MD, Saifuddin A, Molloy S, Briggs TW. A review of the surgical management of sacral chordoma. Eur J Surg Oncol. 2014;40(11):14121420.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    McMaster ML, Goldstein AM, Bromley CM, Ishibe N, Parry DM. Chordoma: incidence and survival patterns in the United States, 1973-1995. Cancer Causes Control. 2001;12(1):111.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Chugh R, Tawbi H, Lucas DR, Biermann JS, Schuetze SM, Baker LH. Chordoma: the nonsarcoma primary bone tumor. Oncologist. 2007;12(11):13441350.

  • 6

    Scampa M, Tessitore E, Dominguez DE, et al. Sacral chordoma: a population-based analysis of epidemiology and survival outcomes. Anticancer Res. 2022;42(2):929937.

  • 7

    Soo MY. Chordoma: review of clinicoradiological features and factors affecting survival. Australas Radiol. 2001;45(4):427434.

  • 8

    Gokaslan ZL, Zadnik PL, Sciubba DM, et al. Mobile spine chordoma: results of 166 patients from the AOSpine Knowledge Forum Tumor database. J Neurosurg Spine. 2016;24(4):644651.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Yang Y, Li Y, Liu W, Xu H, Niu X. The clinical outcome of recurrent sacral chordoma with further surgical treatment. Medicine (Baltimore). 2018;97(52):e13730.

  • 10

    Fourney DR, Gokaslan ZL. Current management of sacral chordoma. Neurosurg Focus. 2003;15(2):E9.

  • 11

    Zuckerman SL, Lee SH, Chang GJ, et al. Outcomes of surgery for sacral chordoma and impact of complications: a report of 50 consecutive patients with long-term follow-up. Global Spine J. 2021;11(5):740750.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Bulat E, Chakravarthy V, Crowther J, Rakesh N, Barzilai O, Gulati A. Exceptional cases of spinal cord stimulation for the treatment of refractory cancer-related pain. Neuromodulation. 2023;26(5):10511058.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Traeger AC, Gilbert SE, Harris IA, Maher CG. Spinal cord stimulation for low back pain. Cochrane Database Syst Rev. 2023;3(3):CD014789.

  • 14

    Peng L, Min S, Zejun Z, Wei K, Bennett MI. Spinal cord stimulation for cancer-related pain in adults. Cochrane Database Syst Rev. 2015(6):CD009389.

  • 15

    Lihua P, Su M, Zejun Z, Ke W. Spinal cord stimulation for cancer-related pain in adults. Cochrane Database Syst Rev. 2013(2):CD009389.

  • 16

    Hagedorn JM, Pittelkow TP, Hunt CL, D’Souza RS, Lamer TJ. Current perspectives on spinal cord stimulation for the treatment of cancer pain. J Pain Res. 2020;13:32953305.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Ferraro MC, Gibson W, Rice ASC, Vase L, Coyle D, O’Connell NE. Spinal cord stimulation for chronic pain. Lancet Neurol. 2022;21(5):405.

  • 18

    Noblett KL, Cadish LA. Sacral nerve stimulation for the treatment of refractory voiding and bowel dysfunction. Am J Obstet Gynecol. 2014;210(2):99106.

  • 19

    Cunningham KG, Westney OL. Sacral neuromodulation for the treatment of retention in partial sacrectomy patients. Neuromodulation. 2016;19(8):897900.

  • 20

    García-Larrea L, Peyron R, Mertens P, et al. Electrical stimulation of motor cortex for pain control: a combined PET-scan and electrophysiological study. Pain. 1999;83(2):259273.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    de Andrade DC, Bendib B, Hattou M, Keravel Y, Nguyen JP, Lefaucheur JP. Neurophysiological assessment of spinal cord stimulation in failed back surgery syndrome. Pain. 2010;150(3):485491.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Wolter T, Kieselbach K, Sircar R, Gierthmuehlen M. Spinal cord stimulation inhibits cortical somatosensory evoked potentials significantly stronger than transcutaneous electrical nerve stimulation. Pain Physician. 2013;16(4):405414.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Phimolsarnti R, Waikakul S. Prevalence of neuropathic pain after radical sacral chordoma resection: an observational cohort study with 10-year follow-up. Eur J Orthop Surg Traumatol. 2015;25(suppl 1):S225S231.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005;14(7):798804.

  • 25

    Tsubota S, Higaki N, Nagaro T. A case of neuropathic cancer pain in the lower extremities successfully treated with spinal cord stimulation. Article in Japanese. Masui. 2009;58(11):14601461.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Yakovlev AE, Resch BE. Spinal cord stimulation for cancer-related low back pain. Am J Hosp Palliat Care. 2012;29(2):9397.

  • 27

    Mosiewicz A, Kamieniak P, Mosiewicz-Madejska B, Kaczmarczyk R, Rudzki M, Trojanowski T. Successful spinal cord stimulation for neuropathic pain after subtotal resection of the lumbosacral neurinoma.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Draper LMTW, Kurtom KH. Spinal cord stimulation for pain relief of unresectable sacral chordoma: case report. J Spine Neurosurg. 2017;6:3.

  • 29

    Yakovlev AE, Ellias Y. Spinal cord stimulation as a treatment option for intractable neuropathic cancer pain. Clin Med Res. 2008;6(3–4):103106.

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 608 608 75
PDF Downloads 306 305 21
EPUB Downloads 0 0 0