Presented by:  Dr.Kris Kumar Neurosurgeon, Regina

Age:  53

Sex:  Male

History:

• 1975, 1980,1988 - Developed chronic bilateral sciatic pain worse on the right following disc surgery at L3-4, L4-5 and subsequent laminectomy ofL3-4.

• During these investigations myodil was used for myelography toinvestigate the above spinal disorders.

• Investigations confirmed arachnoiditis secondary to myodilmyelography.

CT myelogram showing arachnoiditis at L345 level.

Treatment:  1989

• Deep brain implant in the left paraventricular grey with good control of pain.

  Lateral skull X-Ray showing DBI location.

Progress:

• 1998 - Coronary artery disease requiring coronary artery bypass.
• May 2000 - As the pain relief was inadequate investigations showed increased impedance in the active electrodes. This was resolved by replacing the old radiofrequency pulse receiver with the Itrel II System so that all four contact points could be utilized. Resumption of pain control.
• January 2001 - Developed a boil in the scalp over the connector site causing an ulcer which is not healing with appropriate therapy.

  Photo of head showing externalized DBI electrodes.

Question:

• Should the deep brain electrode be now removed to allow for the ulcer to heal? If so, how do we manage his pain?
• Remove the left electrode and implant a new one on the opposite side or on the same side after the ulcer has healed?
• Alternate pain management strategy?