Poster 241: Epidural Air Causing Pain and Weakness Following a Placement of Temporary Spinal Cord Stimulator Leads: A Case Report

Background: The use of magnetic resonance imaging (MRI) is continuously escalating for the evaluation of patients with persistent pain following lumbar spine surgery (LSS). Spinal cord stimulation (SCS) therapy is being clinically applied much more commonly for the management of chronic pain following LSS. There is an increased probability that these 2 incompatible modalities may be accidentally used in the same patient. Objectives: The purpose of this case report is to: (1) summarize a case in which a patient with a thoracic spinal cord stimulator underwent a diagnostic lumbar MRI, (2) describe the 3 magnetic fields used to generate images and their interactions with SCS devices, and (3) summarize the present literature. Study design: Case report. Setting: University hospital. Results: Aside from mild heat sensations in the generator/pocket site and very low intensity shocking sensations in the back while in the MRI scanner, the patient emerged from the study with no clinically detected adverse events. Subsequent activation of the SCS device would result in a brief intense shocking sensation. This persisted whenever the device was activated and required Implantable Pulse Generator (IPG) replacement. Electrical analysis revealed that some of the output circuitry switches, which regulate IPG stimulation and capacitor charge balancing, were damaged, most likely by MRI radiofrequency injected current. Limitations: Single case of a patient with a thoracic SCS having a lumbar MRI study. Conclusion: This case demonstrates the lack of compatibility of lumbar MRI and the Precision SCS system as well as one of the possible patient adverse events that can occur when patients are exposed to MRI outside of the approved device labeling. Key words: Spinal cord stimulation devices, magnetic resonance imaging

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Severe Leg Pain Following Spinal Cord Stimulator Implantation – A Case Report

PM&R ◽

10.1016/j.pmrj.2018.09.024 ◽

2019 ◽

Vol 11 (3) ◽

pp. 317-321

Author(s):

Weibin Shi ◽

Shannon Schultz ◽

David R. Gater

Keyword(s):

Spinal Cord ◽

Case Report ◽

Leg Pain ◽

Spinal Cord Stimulator

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Management of Pulmonary Emboli During a Spinal Cord Stimulator Trial: A Case Report

Pain Management Case Reports ◽

10.36076/pmcr.2020/4/51 ◽

2020 ◽

pp. 51-55

Author(s):

Varun Rimmalapudi

Keyword(s):

Spinal Cord ◽

Case Report ◽

Spinal Cord Stimulation ◽

Pulmonary Embolus ◽

Vena Cava ◽

Multidisciplinary Care ◽

Prior History ◽

Lead Removal ◽

Pulmonary Emboli ◽

Spinal Cord Stimulator

Background: Neuromodulation has been used in the management of chronic pain for well over 30 years and is becoming increasingly relevant in the face of the ongoing opioid epidemic. Although this therapy continues to provide pain relief and improvement in function to patients with a wide variety of pathologies, several complications have been described ranging from lead migration to development of a granuloma causing cord compression. Although not described in the literature, a pulmonary embolism can be one of the rare complications of a spinal cord stimulation procedure, and when it happens during the trial period of spinal cord stimulation, it involves significant challenges in the clinical management of anticoagulation in the patient. Case Report: We present a case in which a patient developed bilateral pulmonary emboli (PE) during the trial phase of spinal cord stimulation. The patient did have a prior history of PE, had an inferior vena cava filter in place, and was on anticoagulation, which was held as per the current American Society of Regional Anesthesia guidelines prior to the spinal cord stimulator (SCS) trial. Conclusion: A pulmonary embolus is a possible complication from an SCS trial, especially in patients with preexisting thromboembolic risk factors. Management must involve multidisciplinary care focused on balancing the risks of thrombosis with those from a potential epidural hematoma at the time of lead removal. Key words: Spinal cord stimulation, pulmonary embolus, spinal cord stimulator complications, neuromodulation, venous thromboembolism, SCS trial, VTE, PE

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Combined Paresthesia and Subperception Spinal Cord Stimulator Therapy for Management of Persistent Pain After Spinal Fusion Surgery for Congenital Scoliosis

Pain Management Case Reports ◽

10.36076/pmcr.2021/5/33 ◽

2021 ◽

pp. 33-36

Author(s):

James C. Burns

Keyword(s):

Spinal Cord ◽

Chronic Pain ◽

Back Pain ◽

Case Report ◽

Spinal Fusion ◽

Congenital Scoliosis ◽

Low Back ◽

Spinal Cord Stimulator ◽

Fusion Surgery ◽

Spinal Fusion Surgery

Background: A significant number of patients who undergo spinal fusion surgery are managed in chronic pain clinics for low back pain or what is commonly described as failed back surgery syndrome (FBSS). There are a multitude of reasons for chronic long standing back pain after surgery, and the etiology is often multifactorial involving both preoperative and postoperative risk factors. In patients with scoliosis, it has been shown that fusion with Harrington rods extending into the lumbar region is associated with increases in postoperative back pain, especially with fusions to the L4-L5 region. Spinal cord stimulation (SCS) is a recognized treatment for this condition after repeat surgery or when conservative treatments have failed. Case Report: This case report describes the use of SCS with combination therapy in the management of severe low back pain after thoracolumbar fusion with Harrington rods in a patient with congenital scoliosis. After a failed trial of conservative medical management, a spinal cord stimulator capable of delivering combination traditional paresthesia with subperception and burst stimulation was placed. Regarding the choice of SCS therapy, there is a vast array of choices including traditional paresthesia, paresthesia-free, subperception, microburst, or combination treatment. The latter is capable of delivering multiple therapies over time designed to provide more thorough and longer-lasting relief. Conclusion: Simultaneous traditional paresthesia and subperception waveform therapy might offer superior pain relief in comparison to therapies utilizing a sing=le waveform. Further studies are needed to evaluate the use of combination over traditional SCS therapy for the treatment of axial back pain secondary to FBSS. Key words: Chronic pain, combination therapy, congenital scoliosis, neuromodulation, spinal cord stimulator, spinal fusion

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