Thoracic Radiculopathy following Spinal Cord Stimulator Implantation Treated with Corticosteroids.
BACKGROUND
Spinal cord stimulation has been used since 1967 to manage chronic neuropathic pain. Although effective, the literature describes the complication rate to be as high as 35%. One rare complication following spinal cord stimulator (SCS) implantation is the development of radicular pain. We present a case series of 2 patients implanted with SCSs who developed thoracic radiculopathy following implantation that resolved with corticosteroids.


METHODS
Although this complication was previously thought to require surgical intervention, this case series describes the use of corticosteroids to resolve postimplantation thoracic radiculopathy. Two patients were studied in this case series who received permanent thoracic implantation of a paddle lead SCS. Several days later, both developed back pain radiating toward the umbilicus in a dermatomal pattern consistent with thoracic radiculopathy. Corticosteroids were administered to relieve this pain. One received 6 mg dexamethasone intravenously every 6 hours followed by an oral dexamethasone taper for 1 week. The other was treated with an oral methylprednisolone taper for 2 weeks.


RESULTS
Upon follow-up, both patients no longer complained of the thoracic radiculopathy and were satisfied with the pain relief the stimulators provided.


CONCLUSIONS
In conclusion, postsurgical radicular pain is a rare but troubling complication of SCS implantation. In order to avoid further surgical complications or the need to explant a device that provides satisfactory paresthesia coverage, pharmacologic management is desirable. This case series has demonstrated that the use of corticosteroids can effectively resolve postimplantation thoracic radicular pain in a specific subgroup of patients.
Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
Ritam
R
Ghosh
Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
Ryan
R
Holland
Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA. Electronic address: antonios.mammis@rutgers.edu.
Antonios
A
Mammis
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage*; D003907:Dexamethasone / Q000008:administration & dosage; D004567:Electrodes, Implanted / Q000009:adverse effects; D006801:Humans; D008775:Methylprednisolone / Q000008:administration & dosage; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011843:Radiculopathy / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology*; D062187:Spinal Cord Stimulation / Q000009:adverse effects / Q000295:instrumentation; D013904:Thoracic Vertebrae
D000305:Adrenal Cortex Hormones; D018712:Analgesics, Non-Narcotic; D003907:Dexamethasone; D008775:Methylprednisolone
Complications; Corticosteroids; Procedure; Spinal cord stimulation; Spine; Steroids; Surgery; Thoracic radiculopathy