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21KF-054
Upgrade of implanted pulse generator using adapter: a case report

JueunKwak1, Shujung Choi1, Ho Sik Moon2

The Catholic University of Korea Yeouido St. Mary’s Hospital1

The Catholic University of Korea Eunpyeong St. Mary’s Hospital2

Introduction
One of the major pitfalls of spinal cord stimulator (SCS) or peripheral nerve stimulators (PNS) is diminishing treatment efficacy. For compensation, various auxilary stimulating methods can be attempted. We hereby report a case of succesful pain alleviation of a patient who experienced decreasing effectiveness of both SCS and PNS, after replacement to a implanted pulse generator (IPG) which offers burst stimulation mode.

Case
A 41-year-old male was diagnosed of left brachial plexus injury after a tragic motorcycle accident 20 years ago. At the time of injury, the patient immediately underwent nerve transfer, but suffered from extreme pain (numerous rating scale (NRS) 9) and complete paralysis of left upper extremity postoperatively. In treatment, SCS (Medtronics) to cervical cord was implanted nine years ago, followed by PCS insertion to the axillary six years ago. The pain decreased to NRS 5, but once again experienced aggravated pain back to NRS 9 from four years after the PCS insertion. At the moment, nine years have passed after the first SCS implantation, hence it was replaced with a new SCS (Abbott) using an adapter (PrecisionTM M8 adapter, Boston Scientific). Burst stimulation mode of replaced implant provided pain alleviation to NRS 5.

Conclusion
Considering minor variations in mechanisms of nerve stimulation techniques among manufacturers, limited actions of pain alleviation can only be provided to the patient in selecting a stimulator. Tolerance to a certain mechanism of SCS or PCS can be built up, when a monotonous stimulation is applied to a patient for long term. For these conditions, changing IPG offering other types of stimulation while using adapters to allow multiple modes, might aid in further improving therapeutic effects.