Successful spinal cord stimulation in a patient with persistent spinal pain syndrome type 2 and a leadless pacemaker: A case report

Lumbar spinal stenosis in older adults may progress to persistent type 2 spinal pain syndrome (PSPS) type 2, for which spinal cord stimulation (SCS) is an established treatment option. However, electromagnetic interference (EMI) remains a major concern in patients with implantable cardiac devices, particularly in the presence of leadless pacemakers (LPM). Herein, we describe the case of a 63-year-old woman with PSPS type 2 after L4–5 interbody fusion and L3–4 laminectomy. Severe back and leg pain persisted despite repeated nerve blocks and opioid treatment, and SCS was planned. Comorbidities included end-stage renal disease requiring hemodialysis, rheumatoid arthritis, and sick sinus syndrome treated with the Aveir VR LP LSP112V (Abbott) LPM. Baseline chart-based outcomes showed overall/resting/movement numerical rating scale (NRS) scores of 10/9/10 (preoperative day 1), EuroQol-5 dimensions-5 levels (EQ-5D-5L) utility of 0.1007, and symptom-limited walking distance of 75 m (15 days preoperatively). The EMI mitigation protocol codeveloped by the medical safety team and cardiologists consisted of bipolar programming, stepwise output escalation, and continuous 24-h electrocardiographic telemetry. Two Octrode leads were placed at the upper border of T8, and tonic and BurstDR stimulations were delivered in the bipolar mode. Continuous stimulation at 2.0 mA and tonic stress testing at 12.0 mA produced no EMI. The walking distance improved to 200 m by postoperative day (POD) 8 and reached 210 m on POD 12. POD 12, overall/resting/movement NRS improved to 7/5/7 and EQ-5D-5L to 0.5517. Pain fluctuated during the long-term follow-up, but at approximately 13 months, the NRS was 8/5/8, and the EQ-5D-5L was 0.5594, with oxycodone reduced to 10 mg/day (from 20 mg/day preoperatively). No EMI was detected during any device checks. Despite a modest overall NRS reduction (30%), improvements in walking distance (75 m – 210 m), HRQoL (EQ-5D-5L 0.10 – 0.55), and opioid requirements indicated clinically meaningful multidimensional benefit. This case supports the feasibility and safety of SCS after LPM implantation, using a multidisciplinary protocol.