Patient-Reported Outcomes with Peripheral Nerve Stimulation for Low Back Pain from Vertebral Plana Deformities: A Case Series

Abstract

Objectives: This study evaluated peripheral nerve stimulation (PNS) as a treatment for vertebra plana fractures, focusing on its impact on pain intensity, physical function, anxiety, depression, fatigue, social role participation, and pain interference. The goal was to assess whether PNS could serve as a minimally invasive alternative for managing pain in patients with severe vertebral fractures. Methods: Four patients with lumbar vertebra plana fractures received PNS implants for 60 days. Pain scores and PROMIS-29 domains (physical function, anxiety, depression, fatigue, social participation, and pain interference) were assessed at 30, 60, 90, 180, and 365 days post-implantation. Data analysis included mean and standard deviation calculations. Results: PNS led to marked improvements in pain-related outcomes. The average pain intensity scores dropped from 8.5 at baseline to 4.25 at one year, and pain interference scores declined from 61.75 to 54.75. Physical function initially decreased but improved from 38.5 at three months to 46.75 at one year. Changes in depression, anxiety, fatigue, and social participation were minimal, reflecting their multifactorial nature and limited response to pain relief alone. Conclusions: This case series suggests that PNS may significantly reduce pain and pain interference while enhancing physical function in patients with vertebra plana fractures. Its sustained benefits highlight PNS as a promising minimally invasive treatment, especially for those ineligible for traditional procedures. However, the limited improvement in psychological and social domains underscores the need for comprehensive care strategies. Further research is warranted to explore the broader role of PNS in managing vertebral fracture pain.

Keywords: acute pain; cancer pain; chronic pain; neuromodulation; peripheral nerve stimulation; plana fracture; temporary PNS.

Figure 1

T2 imaging of L4 vertebral plana fracture in Case 1.

Figure 2

T1 imaging of L4 plana fracture in Case 1.

Figure 3

Changes in pain score over time.

Figure 4

Change in pain scores and physical function scores over time for Case 1.

Figure 5

Fluoroscopic image of PNS needle tip at L4 for L4 placement targeting bilateral L3–L4 and L4–L5 medial nerve branches in Case 2.

Figure 6

Change in pain scores and physical function scores over time for Case 2.

Figure 7

Change in pain scores and physical function scores over time for Case 3.

Figure 8

Change in pain scores and physical function scores over time for Case 4.