Progressive Paraplegia from Spinal Cord Stimulator Lead Fibrotic Encapsulation: A Case Report.
Ten years after placement of a spinal cord stimulator (SCS) and resolution of pain, this patient presented with progressive paraplegia, worsening thoracic radicular pain at the same dermatome level of the electrodes, and bowel and bladder incontinence. Computed tomographic myelogram confirmed thoracic spinal cord central canal stenosis at the level of electrodes. After removal of the fibrotic tissue and electrodes, the patient had resolution of his thoracic radicular pain and a return of his pre-SCS pain and minimal neurologic and functional return. To the authors' knowledge, no studies have been identified with thoracic SCS lead fibrosis in the United States causing permanent paraplegia. Only one other case has been reported in Madrid, Spain. Patients with SCS presenting with loss of pain relief, new-onset radicular or neuropathic pain in same dermatome(s) as SCS electrodes, worsening neuromuscular examination, or new bladder or bowel incontinence need to be evaluated for complications regarding SCS implantation causing spinal stenosis and subsequent cord compression to avoid permanent neurologic deficits.
From the Departments of Rehabilitation Medicine (JB) and Neurosurgery (AM), University of Texas Health Science Center San Antonio; and Department of Surgery, Audie L. Murphy Veteran's Affairs Hospital, San Antonio, Texas (FE).
Jon
J
Benfield
Asif
A
Maknojia
Franklin
F
Epstein
D004567:Electrodes, Implanted / Q000009:adverse effects*; D055111:Failed Back Surgery Syndrome / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D062187:Spinal Cord Stimulation / Q000009:adverse effects* / Q000295:instrumentation; D013130:Spinal Stenosis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D013904:Thoracic Vertebrae; D013997:Time Factors