Management of HIV-Related Polyneuropathy with Spinal Cord Neuromodulation : A New Clinical Indication Vinaya K. Puppala , MD, Zeb McMillan, MD, N. Nick Knezevic , MD, PhD, Kenneth D. Candido , MD Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657 USA.
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Management of HIV-Related Polyneuropathy with Spinal Cord Neuromodulation: A New Clinical IndicationVinaya K. Puppala, MD, Zeb McMillan, MD, N. Nick Knezevic, MD, PhD, Kenneth D. Candido, MDDepartment of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657 USA
Spinal cord stimulation (SCS) is a well-established technique currently indicated for management of failed-back surgery syndrome (FBSS),1 complex regional pain syndrome (CRPS),2 inoperable peripheral vascular disease (PVD),3 and refractory angina pectoris.4We describe the first reported case utilizing spinal cord stimulator neuromodulation to safely and effectively manage debilitating pain in a 50-year-old male with HIV-related polyneuropathy refractory to conservative treatments.
HIV-related neuropathy may thus be an important new clinical application for SCS neuromodulation in addition to existing indications of FBSS, CRPS, PVD, and refractory angina.
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Figure 1. Intraoperative lateral fluoroscopic view revealing first SCS lead satisfactorily directed into dorsal epidural space
Figure 2. Intraoperative anteroposterior fluoroscopic view revealing two SCS leads satisfactorily directed to T9-T10 interspace