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A New Way to Give an Old Vet Relief

Nervous system: nerve pain in the feet can start in the spineThe patient–we’ll call him “Harry” for the sake of anonymity–was a 77 year old Korean War Veteran who suffered from pain and numbness on the tops and bottoms of both his feet. This was caused by nerve damage he had gotten from multiple episodes of frostbite during the war.

After unsuccessfully being treated with physical therapy and a number of pain relieving drugs, Harry was sent to see Dr. Christopher J. Winfree from Columbia’s Peripheral Nerve and Pain Centers.

With stubborn nerve pain like Harry’s, neurosurgeons like Dr. Winfree can implant an electrical nerve stimulating (ENS) device in the spine for pain relief. Harry was a candidate for this because of the very specific pattern of his symptoms: his doctors could trace the irritated nerves in his feet back to a specific spinal segment where these nerves emerged from the spinal cord.

Dr. Winfree felt that placing the nerve stimulating device in a spot where the nerve emerged from the spine (a bony tunnel called the foramen) would give Harry the most targeted pain relief.

The surgery involves placing electrodes that can deliver small pain-relieving electrical impulses to the area. The charge comes from a battery powered unit, similar to it’s cousin, the pacemaker, that is placed just under the skin. Using a remote control, the patient can then control the intensity of the stimulation.

The specific technique that Dr. Winfree used for Harry’s surgery was called, Transforaminal Nerve Root Stimulation. Here is a breakdown in meaning of the words that make up this term:

  • Transforaminal: passing through the tunnel on the side of the spine where the nerve comes out of the spinal cord
  • Nerve root: the name for a nerve when it first comes out of the spinal cord
  • Stimulation: low level electrical impulses

It can be tricky to implant an electrode in this particular spot (the foramen) because this exit tunnel is small and narrow. And as a person gets older and the spine degenerates, it gets even harder to access.

Dr. Winfree found a clever way to sequentially use three different shaped probes to guide the electrode into the narrow space. He says it was actually faster, easier, and requires less radiation from guiding X-Rays to access the foramen from the inside out. Here is how he did it.

He started by making a small incision in the skin above the level of the spine where the troublesome nerve was located. He then cut a small segment of bone out of the back to access the spinal canal.

Using a slightly curved probe, Dr. Winfree threaded the electrode down the canal and over to the side where the foramen is. Once at the foramen entrance, he switched to a highly curved probe to guide the electrode around the corner and into the narrow passage.

Then, he switched again to a straight probe that wouldn’t get hung up on the nerve root and pushed the electrode into place. In the end, four electrodes where successfully placed at two levels of the spine to target both Harry’s feet.

Where and how these electrodes were placed in Harry’s spine was the subject of a paper Dr. Winfree and his colleagues published in the journal Neuromodulation.

Learn more about Dr. Christopher Winfree on his bio page here.

Originally Published on: Dec 16, 2009
Updated on Nov 18, 2016

Image credit: magicmine / Adobe Images

patient journey

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