Introduction: The treatment of pelvic neuropathic pain and or interstitial cystitis (IC) with spinal cord stimulation (SCS) in most cases involves retrograde placement of percutaneous single- or dual-lead contact arrays over the S2-S3 nerve root. Retrograde approaches into the sacrum present with challenges associated with limited epidural space and spinal curvature. The challenge with an anterograde approach is that the pelvic area is difficult to capture since sensory fibers are more central and deep. We report a novel case where leads placed anterograde and over the nerve roots gave near complete amelioration of pain.

Materials and Methods: A 26-year-old woman presented with a 1-year history of chronic intractable pelvic pain and interstitial cystitis. Using Medtronics dual 8-contact percutaneous linear leads for an SCS-Trial, leads were placed retrograde from an entry point at L3-L4. The leads were first threaded down inferiorly to approach S2-S3, but adequate analgesic coverage was not obtained. Leads and epidural needles were then removed. At the time, we developed a novel approach where the original 2 leads were positioned through the interlaminer space at L3-L4 and directed anterograde into the epidural "gutter". Final position was bilaterally over the T11-T12 nerve roots. After a successful 1 week SCS-Trial, permanent leads and a generator were placed into a pocket within the upper buttock.

Results: During a 1 week trial, the patient received great stimulation coverage and analgesia over the painful pelvic area. With the permanent SCS system, the patient reports a 90% decrease in pain and has since been maintained without complications.

Conclusion: These results demonstrated that SCS leads placed anterograde to L3-L4 and over nerve roots T11-T12 gave near complete amelioration of pelvic pain associated with interstitial cystitis, when stimulated. The patient was able to return to work as a school teacher and wean off her medications.