A Case Series on Total Ankle Arthroplasty Following High-Frequency Spinal Cord Stimulation in Peripheral Neuropathy Patients

Abstract

Introduction: Patients with peripheral neuropathy (PN) who undergo high-frequency spinal cord stimulation (HF SCS) therapy may now benefit from total ankle arthroplasty (TAA). This patient population was previously excluded from eligibility for TAA as PN was an absolute contraindication. Now, risks of PN are reduced through HF SCS therapy, involving the surgical implantation of a device in the patient’s epidural space, ultimately interrupting the central processing of peripheral nerves and providing disease-modifying neurological improvements. These improvements diminish the risks faced by patients with PN, making them eligible to receive TAA. This case report seeks to determine whether TAA is a viable option for patients who have had their PN improved with HF SCS therapy. Methods: We performed TAA on three patients with PN whose symptoms were previously improved with HF SCS therapy. Radiographic and functional outcome data was collected on these patients for 12-19 months postoperatively. Results: Functional and radiographic follow-up over 12-19 months showed favorable outcomes with no major postoperative complications, suggesting safety and feasibility. Conclusion: The results of this case series show that TAA is a viable treatment option for patients with PN who undergo HF SCS therapy to manage their symptoms and should no longer be considered an absolute contraindication for this population. By providing potentially disease-modifying neurological improvement, including motor strength, reflexes and sensation, HF SCS therapy diminishes the risk factors associated with PN and allows for a safe postoperative course following TAA. To our knowledge, there are no reports described in the literature of TAA being performed on this patient population. This case report will add to the evidence in support of expanding the indications for TAA to include individuals with PN being managed with HF SCS therapy.