Perioperative Management of a Patient With Primary Adrenal Insufficiency Undergoing Spinal Cord Stimulation: A Case Report.

BACKGROUND

Spinal cord stimulation (SCS) is an established therapy for the management of chronic neuropathic low back pain (LBP) that is refractory to conventional measures. Although considered minimally invasive, SCS constitutes a surgical intervention that may induce significant physiological stress, placing patients with primary adrenal insufficiency (PAI) at an elevated risk of adrenal crises during perioperative periods.

CASE REPORT: The authors present a woman with chronic LBP and PAI who successfully underwent SCS trial and permanent implantation with stress-dose glucocorticoid supplementation perioperatively, which resulted in 90% pain reduction, improved functional capacity, decreased analgesic reliance, and no adrenal crisis. To the authors' knowledge, there are no published clinical guidelines that address perioperative glucocorticoid management in PAI patients undergoing SCS implantation.

CONCLUSIONS

Our case highlights a safe and effective perioperative protocol for SCS in PAI patients and underscores the importance of endocrine comorbidities when undergoing interventional procedures.