title: A report of paraparesis following spinal cord stimulator trial, implantation and revision.
abstract: BACKGROUND
  Spinal cord injury has been reported as a rare complication of spinal cord stimulation (SCS). A review of the literature shows a very low incidence of neurological injury after spinal cord stimulation trial, implantation and revision. The most common reported complication is equipment failure without neurologic injury. The incidence of spinal cord injury after SCS trial, implantation and revision is unknown. There have been limited reports of neurologic injury secondary to dural puncture, infection, cord contusion, actual needle penetration of the spinal cord and epidural hematoma.
  
  
  METHODS
  A report of 4 cases.
  
  
  OBJECTIVE
  To report 4 occurrences of neurological complication after spinal cord stimulator implantation.
  
  
  METHODS
  Four patients are presented who were admitted to an acute spinal cord rehabilitation hospital over a 4-month period. All 4 patients presented with paraparesis after spinal cord stimulator trial or implantation. One of the injuries is secondary to cord contusion, while the other 3 are secondary to cord compressions. Two of these compressions are due to epidural hematomas and one secondary to implantation in the setting of broad based thoracic disc herniations. The clinical cases are presented as well as a review of the literature.
  
  
  RESULTS
  All 4 patients had the electrodes and neurostimulators successfully removed prior to their acute rehabilitation admissions. At discharge from acute inpatient rehabilitation, one patient continued to experience complete paraplegia, 2 patients had incomplete paraparesis and one had fully recovered all of his neurologic function.
  
  
  CONCLUSIONS
  SCS is considered a safe procedure. Further investigation into the true incidence of neurologic injury after SCS is warranted.
authors.affiliation: Emory University, Shepherd Center, Atlanta, GA, USA. ccsmit5@emory.edu
authors.forename: Clark C
authors.initials: CC
authors.lastname: Smith
authors.forename: John L
authors.initials: JL
authors.lastname: Lin
authors.forename: Max
authors.initials: M
authors.lastname: Shokat
authors.forename: Sonny S
authors.initials: SS
authors.lastname: Dosanjh
authors.forename: Dionne
authors.initials: D
authors.lastname: Casthely
mesh_terms: D000328:Adult; D000368:Aged; D004599:Electric Stimulation Therapy / Q000009:adverse effects* / Q000295:instrumentation; D004567:Electrodes, Implanted / Q000009:adverse effects; D004824:Epidural Space / Q000033:anatomy & histology / Q000601:surgery; D005260:Female; D046748:Hematoma, Epidural, Spinal / Q000150:complications / Q000175:diagnosis; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D017116:Low Back Pain / Q000209:etiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020335:Paraparesis / Q000175:diagnosis / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology; D019919:Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D012086:Reoperation / Q000009:adverse effects / Q000379:methods; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000209:etiology*