SCS for bilateral foot pain related to Bannayan-Riley-Ruvalcaba Syndrome
A. Yakovlev, MD; L. Fields, APNP; and, A. Parmentier, APNP
Comprehensive Pain Management of The Fox Valley, Appleton, WI, USA
Introduction: Bannayan-Riley-Ruvalcaba Syndrome (BRRS) is characterized by craniofacial, somatic, motor and intellectual development conditions, skin, gastrointestinal system, neoplasms, skeletal system and other abnormalities are experienced in different degrees. This case reports on a 22-year-old female with a predominant skeletal abnormality — gigantism of the feet causing intractable bilateral combined joint and neurologic foot pain.
Methods: We report successful spinal cord stimulator trial and permanent implantation in a 22-year-old female patient with bilateral foot pain diagnosed with BRRS.
Results: A 23-year-old female presenting to our clinic after seeing several orthopedic specialists who indicated no surgical intervention was indicated. She was facing permanent disability due to the pain, after conservative therapy failed, neuromodulation was considered. During the trial two 8 electrode leads placed in the posterior epidural space the tip at the levels of T8-9, and T10. Both leads were connected to a temp generator. This resulted in report of greater than 90% relief of pain, and no use of immediate release morphine. Decision was made to proceed with permanent placement at a later date. Patients reports the stimulation covers 100% relief of pain and 60% decrease of Morphine use within the first four months post operative, and 100% pain relief and no use of Morphine six months after implant.
Conclusions: Spinal cord stimulation for treatment of foot pain related to BRSS is a treatment that can decrease and/or eliminate use of opioids in the young adult while improving quality of life is worth further exploration.
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