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Pain and Spine Medicine

Simultaneous Closed Loop Inceptiv Spinal Cord Stimulator and Bladder InterStim Implantation: A Case Report

Saturday, October 25, 2025
8:00 AM - 9:15 AM MT
Location: Kiosk 4

    Primary Author(s)

  • Maanas Chiplunkar, DO

    PM&R Resident
    New York University Grossman School of Medicine PM&R Program
    New York, New York

    • Co-Author(s)

  • DB

    Dylan Banks, MD

    Resident
    New York University Grossman School of Medicine PM&R Program
    New York, New York

  • David S. Jevotovsky, MD

    Resident Physician
    New York University Grossman School of Medicine PM&R Program
    New York, New York

  • MB

    Mustafa Broachwala, DO

    Interventional Pain Physician
    UCSD Department of Anesthesia and Pain
    San Diego, California

    • Co-Author(s)

  • Joseph Kastrenakes, DO

    Resident
    New York University Grossman School of Medicine PM&R Program
    New York, New York

Disclosure(s):
Maanas Chiplunkar, DO: No financial relationships to disclose
David S. Jevotovsky, MD: No financial relationships to disclose
Joseph Kastrenakes, DO: No financial relationships to disclose
Case Diagnosis: Overactive bladder syndrome in chronic lower back pain

Case Description or Program Description: A 69-year-old male with a history of chronic low back pain (cLBP), severe lumbar stenosis with epidural lipomatosis, diabetic peripheral neuropathy, and overactive bladder (OAB) presented with debilitating pain (6–8/10) in the lower back, bilateral hips, legs, gluteal muscles, and coccygeal region. He also experienced severe burning in his feet, significantly impairing his mobility. At most, he could walk 20–30 feet with a cane and otherwise relied on a wheelchair for community ambulation. Previous pharmacologic, physical, and interventional treatments, including epidural steroid injections, radiofrequency ablation, and physical therapy, provided minimal relief.

Setting: Outpatient Pain Medicine

Assessment/Results: The patient initially underwent spinal cord stimulation (SCS) implantation, resulting in 90% pain relief, opioid cessation, and improved mobility. However, following a mechanical fall four years post-implantation, he experienced a recurrence of severe pain and functional decline. Device interrogation revealed nonfunctional leads, prompting SCS revision with a Medtronic Closed Loop Inceptiv system. Simultaneously, he underwent stage II implantation of a four-lead InterStim sacral neuromodulation (SNM) system for OAB. Postoperatively, he reported significant pain reduction, restored mobility, and a 50% reduction in voiding frequency, with improved sleep and posture.

Discussion (relevance): This is the first reported case of simultaneous implantation of an Inceptiv closed-loop SCS and an InterStim SNM system. The patient demonstrated substantial improvements in pain management, mobility, and OAB symptoms, suggesting potential synergistic effects. The findings align with existing large-scale studies on the individual efficacy of CL-SCS and SNM but highlight the need for further research on their combined use. The interrelationship between cLBP and OAB may involve shared neural mechanisms, spinal instability, and altered viscerosomatic convergence.

Conclusions: This case supports the feasibility and potential benefits of dual neuromodulation for cLBP and OAB. Future studies should investigate the long-term efficacy, optimal stimulation parameters, and potential interactions between these neuromodulatory systems.