Contributed by Gustaf M. Van Acker III, MD, Ph.D |Pain Medicine
George Brennan spent more than 35 years on his feet, often walking up to 20,000 steps a day in his work as a quality manager for an automotive company. That, plus being 6 feet 9 inches tall, gradually took a toll on his spine.
George was 57 when, in 2019, he underwent the first of what would be four surgeries over the next four years. He suffered from spinal stenosis – narrowing around his spine – that resulted in pain and imbalance. Following the first surgery on his lower back, George stopped working and went on disability. The pain was just too much to endure every day.
Despite multiple back surgeries and at-home physical therapy, George still experienced debilitating back pain and leg numbness and tingling. He could barely walk and relied on a rolling walker. He had chronic, unexplained pain following back surgery called post lumbar laminectomy syndrome, or Failed Back Surgery Syndrome.
George was referred to Gustaf Van Acker, MD, PhD, a physician on MetroHealth’s Pain Medicine team researching the use of spinal cord stimulation, which traditionally applies electrical stimulation to the back of the spinal cord with the goal to interrupt pain signals from the body.
Dr. Van Acker and Chong Kim, MD, Director of the Pain and Healing Center, believed applying stimulation to the front of George’s spinal cord, where pain signals are transmitted to the brain, would yield superior pain relief than stimulation to the back of the spinal cord. Historically, spinal cord stimulation required patients to undergo more invasive surgery, and placing electrodes at the front of the spinal cord was deemed too difficult.
Dr. Van Acker, however, believed George was a candidate for a less-invasive approach. After assessing his condition and medical history, Dr. Van Acker asked George to consider taking part in a case study on spinal cord stimulation to treat his chronic pain.
Even though he had never heard of spinal cord stimulation, George was willing to give it a try. He wasn’t eager to go through another surgery, and he was tired of how pain medication made him feel like a “space cadet.”
On a scale of 1 to 10, George said his pain was at a nine.
“I wanted to get off of the medication,” he said. “I told Dr. Van Acker, I’m all for that.”
On September 26, 2022, Dr. Van Acker and Dr. Kim inserted three electrical leads underneath the skin on George’s lower back. Two were at the back of the spinal cord. The third was placed in the front.
For the next seven days, electrical stimulation was delivered to the two back electrodes.
One week later, electrical stimulation was added to the front electrode. That change increased the effectiveness of pain relief to George’s spinal cord.
On November 28, 2022, George underwent an outpatient procedure for a full permanent spinal cord stimulation implant with the three electrodes, powered by an internal battery designed to last for seven to 10 years. A couple weeks later during a follow-up appointment, Dr. Van Acker made some minor adjustments to optimize pain relief. Since then, George has returned every few months for adjustments.

George Brennan holds the device he uses to control the spinal cord stimulator parameters.
One year later, George says he’s at 75% and continues to improve. He still needs pain medication, but not nearly as often as before.
Instead of taking 20 Percocet tablets (oxycodone and acetaminophen) a week, he now needs fewer than five. On many days he doesn’t take anything, unless cold weather or high humidity make his neuropathy flare up.
George still uses a rolling walker for extra stability. He walks a mile every day and goes to The MetroHealth Rehabilitation Institute at the Old Brooklyn campus once a week for physical therapy to work on core strength, balance and flexibility.
During the day, George puts the stimulator on a low setting to help manage his pain during the day. Because his neuropathy is worse at night, “That’s when I crank up the voltage,” he said.
Dr. Van Acker and Dr. Kim are in the process of obtaining the regulatory approval needed to move forward with a full clinical study that would look at safety and efficacy. He hopes to be able to start enrolling patients in late 2024.
The results of the case study involving George have been published online and in print.
An analysis of study data 12 months after the trial will soon be submitted.
Over the past year, MetroHealth physicians have used the same implantation technique successfully in four more individuals.
“If I can help the next generation or two by taking part in this, I’m all for that,” George said. “It made such a difference. It’s fantastic.”

George Brennan practices using a cane with physical therapist Darcy Kosmerl.