1207 - A Rare Case of Spinal Cord Damage After Implantation of a Spinal Cord Stimulator: A Case Report

We report a rare case of spinal cord injury after SCS implantation in a 54-year-old female.

Case Description:

A 54-year-old female with previously implanted SCS for back pain secondary to motor vehicle trauma was admitted for reimplantation of a new SCS device following an acute L2 compression fracture that led to significant pain and dysesthesia. The intraoperative course was uncomplicated. Immediately post-operatively, the patient experienced an inability to move her right leg, with MRI showing epidural fluid collections at the level of lead insertion; after subsequent removal of the SCS, the patient continued to experience paralysis in the right leg, with the development of painful neuropathy and allodynia to touch. By postoperative day 4, neuropathy and allodynia had resolved following administration of Pregabalin and Baclofen, but right leg paralysis/weakness persisted. The patient was sent to acute rehabilitation, where her lower limb strength gradually improved, but has not returned to baseline.

Discussions:

The most common complication rate seen is electrode/lead migration, but recent anchoring techniques have been successfully utilized to improve the lead implant's stability. Spinal cord injury is a rare but feared complication, but a recent systematic review of 71,172 patients found an overall low incidence rate of 0.42% (n=302), supporting the notion that SCS is a safe procedure. Numerous changes in the approach to the implantation of SCS have been developed, and intraoperative neuromonitoring has successfully decreased neurological injury post-operatively. Nonetheless, strict monitoring of adverse effects and early intervention are essential in preventing or decreasing the rate and severity of complications. 

Conclusions:

This case provides a useful clinical and procedural case on post-operative spinal cord injury after an uncomplicated SCS implantation. SCS is a safe and efficacious procedure but the importance of preventative measures, intraoperative neuromonitoring, and post-operative care is paramount to the success of this procedure.