Case Report: Beyond chronicity: sustained multidimensional response to spinal cord stimulation three decades after traumatic spinal cord injury.
5 affiliations
- 1Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia.
- 2Faculty of Education and Rehabilitation Sciences, University of Zagreb, Zagreb, Croatia.
- 3School of Medicine, Catholic University of Croatia, Zagreb, Croatia.
- 4School of Medicine, University of Zagreb, Zagreb, Croatia.
- 5Medicine of Sports and Exercise Chair, Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia.
Abstract
Introduction
Spinal cord stimulation (SCS) is an established treatment for refractory neuropathic pain conditions, yet evidence for its effectiveness in spinal cord injury (SCI)-related neuropathic pain, particularly after decades of persistent symptoms, remains limited. It remains unclear whether unusually prolonged pain chronicity and established neurological deficits affect the potential for a meaningful response to neuromodulation.Case presentation
We report a 60-year-old man with chronic incomplete SCI, bilateral spastic paraparesis markedly more pronounced on the left, and severe chronic neuropathic pain following a gunshot-related spinal injury sustained in 1991. Retained metallic fragments were located at T12-L1; however, a formal neurological level of injury and AIS grade could not be reliably reconstructed because a complete contemporaneous ISNCSCI examination was unavailable. The longstanding bilateral lower-extremity pain phenotype was clinically consistent with below-level SCI neuropathic pain, although formal classification was limited by the absence of an ISNCSCI-defined neurological level. After more than three decades of persistent pain refractory to multimodal conservative treatment, permanent SCS was performed with two epidural leads positioned at T8-T9. Stimulation was predominantly DTM-based, supplemented by individualized tonic programming and later activation of closed-loop stimulation. Pain intensity decreased from 8/10 at baseline to 3/10 at 12 months and 2/10 at 24 months. This sustained response was accompanied by improvements in self-reported disability, neuropathic pain features, self-rated health, and psychological well-being, together with sustained discontinuation of pain-directed pharmacological therapy. No neurological deterioration or device-related complications occurred during the 24-month follow-up.Conclusion
This case demonstrates that a clinically meaningful and sustained multidimensional response to SCS can occur despite more than three decades of SCI-related neuropathic pain and established neurological impairment. Given the limited and heterogeneous evidence for SCS in this population, interpret this finding as an individual clinical observation supporting further investigation of neuromodulation in patients with longstanding SCI-related neuropathic pain, rather than as generalizable evidence for patient selection.
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BibTeX
@article{blazevic2026case,
title = {{Case Report: Beyond chronicity: sustained multidimensional response to spinal cord stimulation three decades after traumatic spinal cord injury.}},
author = {Andrea Blažević and Petar Marčinković and Fadi Almahariq and Sven Krušić and Domagoj Dlaka and Darko Chudy and Marina Raguž and Tonko Marinović},
journal = {Frontiers in pain research (Lausanne, Switzerland)},
year = {2026},
month = oct,
doi = {10.3389/fpain.2026.1969355},
url = {https://europepmc.org/article/MED/42909074},
note = {CC BY},
}
RIS
TY - JOUR
TI - Case Report: Beyond chronicity: sustained multidimensional response to spinal cord stimulation three decades after traumatic spinal cord injury.
AU - Andrea Blažević
AU - Petar Marčinković
AU - Fadi Almahariq
AU - Sven Krušić
AU - Domagoj Dlaka
AU - Darko Chudy
AU - Marina Raguž
AU - Tonko Marinović
PY - 2026
DA - 2026/10/07
JO - Frontiers in pain research (Lausanne, Switzerland)
DO - 10.3389/fpain.2026.1969355
UR - https://europepmc.org/article/MED/42909074
AB - Introduction Spinal cord stimulation (SCS) is an established treatment for refractory neuropathic pain conditions, yet evidence for its effectiveness in spinal cord injury (SCI)-related neuropathic pain, particularly after decades of persistent symptoms, remains limited. It remains unclear whether unusually prolonged pain chronicity and established neurological deficits affect the potential for a meaningful response to neuromodulation.Case presentation We report a 60-year-old man with chronic incomplete SCI, bilateral spastic paraparesis markedly more pronounced on the left, and severe chronic neuropathic pain following a gunshot-related spinal injury sustained in 1991. Retained metallic fragments were located at T12-L1; however, a formal neurological level of injury and AIS grade could not be reliably reconstructed because a complete contemporaneous ISNCSCI examination was unavailable. The longstanding bilateral lower-extremity pain phenotype was clinically consistent with below-level SCI neuropathic pain, although formal classification was limited by the absence of an ISNCSCI-defined neurological level. After more than three decades of persistent pain refractory to multimodal conservative treatment, permanent SCS was performed with two epidural leads positioned at T8-T9. Stimulation was predominantly DTM-based, supplemented by individualized tonic programming and later activation of closed-loop stimulation. Pain intensity decreased from 8/10 at baseline to 3/10 at 12 months and 2/10 at 24 months. This sustained response was accompanied by improvements in self-reported disability, neuropathic pain features, self-rated health, and psychological well-being, together with sustained discontinuation of pain-directed pharmacological therapy. No neurological deterioration or device-related complications occurred during the 24-month follow-up.Conclusion This case demonstrates that a clinically meaningful and sustained multidimensional response to SCS can occur despite more than three decades of SCI-related neuropathic pain and established neurological impairment. Given the limited and heterogeneous evidence for SCS in this population, interpret this finding as an individual clinical observation supporting further investigation of neuromodulation in patients with longstanding SCI-related neuropathic pain, rather than as generalizable evidence for patient selection.
SN - 2673-561X
ER -