ECAP ‐Guided Closed‐Loop Spinal Cord Stimulation for Axial Thoracic Pain: A Case Report

Thoracic spine pain is among the least commonly reported pain syndromes. Conventional therapeutic strategies are frequently ineffective and may be associated with adverse events. Closed‐loop spinal cord stimulation (SCS) assisted with evoked compound action potentials (ECAPs) has emerged as a promising, safe and effective alternative. In this case report, we describe the successful use of ECAP‐controlled closed‐loop SCS in a patient with refractory thoracic spine pain. A female patient in her 40s presented with several axial thoracic pain refractory to all conservative and interventional therapies. Upon admission, the numeric rating scale (NRS) for pain score was 8/10. Functional limitations included restricted sleep duration (3 h) and limited standing and walking tolerance (20 min). The patient underwent a one‐week trial of ECAP‐controlled closed‐loop SCS, during which 24 million smart adjustments were automatically performed to maintain consistent neural activation. The dose accuracy was ±5 μV, with a target ECAP of 19.4 μV, and the measure was 16.4 μV, and the patient used the device 100% of the time. Following treatment, the patient reported improvement in pain and functional outcomes, with NRS scores decreasing to 2/10, and substantial improvements in sleep (6 h), standing, and walking duration. This case suggests that ECAP‐assisted closed‐loop SCS may provide meaningful pain relief and functional improvements in patients with refractory spine pain.