Connor D. Swartz, DO
Resident Physician
University of Missouri - Columbia
Columbia, Missouri, United States
Casey Sevy, DO
Attending Physician
University of Missouri (PM&R)
Columbia, Missouri, United States
Evan Reeves, BS
Medical Student
University of Missouri School of Medicine
Columbia, Missouri, United States
Alexa Malik, MD
Resident Physician
University of Missouri
Columbia, Missouri, United States
The patient is an 82-year-old male with past medical history of chronic low back pain (previous L4 laminectomy), paroxysmal atrial fibrillation (not on chronic anticoagulation therapy), that presented to the emergency department after undergoing spinal cord stimulator placement at 1100. After stimulator placement, the patient was discharged home with no complications and could ambulate independently out of the clinic. However, at 1700, the patient began to experience increased lower back pain, progressive weakness and loss of sensation of the bilateral lower extremities. The patient was unable to ambulate and reported one episode of urinary incontinence and significant bleeding from the surgical incision. The patient then presented to the emergency department at an outside hospital at 2000. CT of the lumbar spine was concerning for epidural hematoma, and the patient was subsequently transferred to University Hospital.
Discussions: CT of the thoracic and lumbar spine an epidural hematoma extending from T1-L3, severe spinal canal narrowing at T3-4 and L1-L3, and moderate spinal canal narrowing at T6-T12. The patient underwent an emergent laminectomy at T3-T4 and T12-L1 with hematoma evacuation. The patient was diagnosed with a T9 ASIA A spinal cord injury secondary to epidural hematoma. Spinal epidural hematoma secondary to spinal cord stimulator placement is an exceptionally rare complication. According to the American Society of Regional Anesthesia and Pain Management (ASRA), the incidence rate of epidural hematoma is reported in the literature as 0.25% to 0.30%.
Conclusions:
Given the overall incidence , the potential for such complications to result in severe spinal cord injuries remains significant. The findings from this case study serve to educate both patients and physicians about the exceedingly rare yet potentially catastrophic complications associated with spinal cord stimulator implantation.
