She elected to pursue spinal cord stimulation with the Nevro Senza HF10 system. She was diagnosed with failed back surgery syndrome and counseled regarding her treatment options, including spinal cord stimulation. A nerve conduction study was unremarkable for any pathology. She had previously been unsuccessfully managed with epidural steroid injections and multimodal analgesics. The patient is a 50-year-old female who had a 4-year history of left lumbar radiculopathy which was precipitated from a lifting injury that did not resolve following L4-5 microdiscectomy. In this case report, we present a patient who experienced persistent and disabling tinnitus, vertigo, and perioral numbness with intermittent nausea, vomiting, and diarrhea status after high frequency spinal cord stimulator placement and activation that resolved with deactivation of the device. Moreover, adverse neurologic effects of this therapy are not well known or understood. The precise mechanism of spinal cord stimulation has not been fully elucidated. The first-in-class high frequency spinal cord stimulator to gain FDA approval was the Senza HF10 device from Nevro Corporation (Redwood City, CA). Specifically, high frequency stimulation relies on a continuous waveform delivered at 10 kHz. These include burst stimulation, high pulse density, and high frequency stimulation. Recently, new classes of “paresthesia-free” waveforms have demonstrated long-term durable pain relief. Spinal cord stimulator technology until 2015 had relied on low frequency electrical stimulation in the 50-120 Hz range with either constant-current or constant-voltage waveforms to achieve paresthesia for pain relief. Since then, the technology of spinal cord stimulation has advanced at an accelerated pace. using a single epidural lead programmed at 10-50 Hz tonic frequency. The first clinical report of successful use of spinal cord stimulation (SCS) was described in 1967 by Shealy et al. Spinal cord stimulation is a proven treatment modality for a variety of pain pathologies.
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