# Pain reduction through combined spinal cord stimulation and exercise therapy after spinal extradural arachnoid cystectomy: a case report

## TL;DR

Combining spinal cord stimulation with exercise therapy helped reduce pain and improve function in a patient after spinal surgery.

## Contribution

Demonstrates a novel combination of SCS and exercise for managing post-surgical multifocal pain.

## Key findings

- SCS implantation resolved leg symptoms and enabled exercise initiation.
- Rib pain decreased and muscle mass increased over 12 months.
- Improved pain modulation and functional recovery were observed.

## Abstract

Spinal extradural arachnoid cysts (SEACs) can cause persistent pain after surgery. Combining spinal cord stimulation (SCS) with structured exercise therapy may aid long-term pain modulation.

A teenage female with over two years of severe rib pain and bilateral leg pain/numbness was diagnosed with SEACs and underwent resection. A trial of SCS alleviated leg symptoms; rib pain persisted. After SCS implantation, leg symptoms resolved, and a gradual exercise progressed from pain-free stretching to low-intensity lower-limb exercises. Over 12 months, rib pain decreased and skeletal muscle mass increased. Pressure pain threshold and conditioned pain modulation improved, suggesting reduced sensitization and enhanced descending inhibition.

This case suggests that SCS may provide early pain relief, enabling initiation of structured exercise, associated with sustained pain reduction, improved pain modulation, and functional recovery. These observations suggest the SCS combined with exercise may be a useful option for selected patients with movement-limiting multifocal pain.