A 45-year-old man with persistent radicular left leg pain greater than back pain after two lumbar discectomies has failed conservative therapy and careful medication optimisation. Imaging shows no compressive lesion amenable to revision surgery. Which intervention is MOST appropriate to consider next?

• A Intrathecal baclofen pump insertion
• B Repeat laminectomy with instrumented fusion
• C Lumbar sympathetic block
• D Trial of spinal cord stimulation following psychological screening ✓

Explanation

Failed back surgery syndrome with predominant lower-limb radicular pain is the classic indication for spinal cord stimulation, provided there is no correctable surgical lesion and the patient passes psychological screening; a temporary trial precedes permanent implantation. Repeat fusion in the absence of a compressive lesion or instability offers poor outcomes. D lumbar sympathetic block targets sympathetically maintained pain of the lower limb vasculature, and intrathecal baclofen treats spasticity, so both are anatomically and therapeutically mismatched.

Reference: Benzon's Essentials of Pain Medicine, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.