MOTOR IMAGERY BRAIN-COMPUTER INTERFACE SYSTEM IN PAIN MANAGEMENT AFTER FAILED BACK SURGERY – A CASE REPORT
Kokki Hannu1, Kokki Merja2, Carita Nikkari3
1 School of Medicine, University of Eastern Finland, Kuopio, Finland
2 Department of Anaesthesia and Intensive Care, Kuopio University Hospital, Kuopio, Finland
3 Fysio Center Oy, Jyväskylä, Finland

Background and aims: 
Low back pain is a major cause of disability.1 Success rate of surgery is low and failed back surgery syndrome (FBSS) is common.2

During the last decade brain-computer interface (BCI) -systems have been used increasingly in rehabilitation in stroke patient.3

Here we present a case report where a motor imagery BCI-system was used in treatment of severe FBSS pain.

Methods:
In 1997 young male had three lumbar discectomies at L5-S1. Postoperatively he had chronic lower back pain and foot drop, and later paraesthesia in the left lower extremity than spread into the right lower extremity. He had two spinal cord stimulator implanted in 2005 and 2015. His paraesthesia symptoms spread to Th11-12 level. In clinical examination he had only a degenerative disc disease in lumbar level.
On 1/2019, at age 57 years, he had allodynia in left lower extremity, no proprioseption, and muscle strength was low. He had constant 8/10 pain in lower back and lower extremities. As his pain had nosiplastic characteristics, we decide to try motor imagery BCI-system (recoveriX, g.tec medical engineering GmbH, Schiedlberg, Austria).
Results:
He had BCI treatments three times a week for 12 weeks. After the second session his pain decline and after few sessions pain was 1/10. Now, 12 weeks after the last motor imagery BCI his symptoms were still mild.
Conclusions:
In consistent with reports in stroke patients on upper limb rehabilitation 4, in this case motor imagery BCI-ystem was highly effective on severe nosiplastic pain after FBSS.

References
1. Foster NE et al. Lancet 2018.
2. Nachemson A. Acta Orthop Scand 1993.
3. Irimia D et al. Conf Proc IEEE Eng Med Biol Soc. 2016.
4. Cervera MA et al. Ann Clin Transl Neurol 2018.

MOTOR IMAGERY BRAIN-COMPUTER INTERFACE SYSTEM IN PAIN MANAGEMENT AFTER FAILED BACK SURGERY - A CASE REPORT