Intrathecal Bleed Following Percutaneous Spinal Cord Stimulator Trial Lead Placement

2017 ◽  
pp. 105-111
Author(s):  
Ryan Nobles
Keyword(s):  
Spinal Cord ◽  
Failed Back Surgery Syndrome ◽  
Spinal Epidural Hematoma ◽  
Postanesthesia Care Unit ◽  
Spinal Cord Stimulator ◽  
Blood Products ◽  
Lead Placement ◽  
Patient Reported ◽  
Failed Back Surgery ◽  
Back Surgery

An intrathecal bleed is an exceedingly rare, yet potentially devastating consequence of accessing the epidural space for lead placement during a spinal cord stimulator trial. We present a case of radiologic evidence of intrathecal blood products and the neurologic consequences thereof following a percutaneous spinal cord stimulator trial. A 34-year-old man with a primary diagnosis of failed back surgery syndrome underwent percutaneous spinal cord stimulator lead placement. During the trial, the patient experienced paresthesia with initial right-side lead placement at T12-L1. The lead and needle were removed and placed at L1-2 where the patient did not report any problems. The patient reported right calf pain in the postanesthesia care unit following the trial that improved with intravenous hydromorphone. However, following discharge the patient experienced worsening dysesthesia with edema of the right lower extremity to the calf. Magnetic resonance imaging of the lumbar spine confirmed the presence of blood products within the intrathecal space. Spinal cord stimulator placement may be viewed as a safe and effective treatment modality despite the incidence of several neurologic, mechanical, and biologic complications. A few case reports discuss the occurrence of spinal epidural hematoma formation but none present a case of an intrathecal bleed following percutaneous spinal cord stimulator lead placement. This case report highlights the need to further elucidate the incidence of neurologic sequelae after spinal cord stimulator placement. Key words: Spinal cord stimulation, antiplatelets, anticoagulation, intrathecal bleed, complications, failed back surgery syndrome

Lead extrusion ten months after spinal cord stimulator implantation: a case report

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
David Reehl ◽  
Thomas Cheriyan ◽  
Owais Qureshi ◽  
Zhuo Sun ◽  
Paramvir Singh ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Low Back Pain ◽  
Back Pain ◽  
Case Report ◽  
Rare Complication ◽  
Failed Back Surgery Syndrome ◽  
Low Back ◽  
Spinal Cord Stimulator ◽  
Failed Back Surgery ◽  
Back Surgery

AbstractObjectivesThe purpose of this case report is to describe an occurrence of a rare complication of lead extrusion, which was observed 10 months after spinal cord stimulator (SCS) implantation.MethodsA patient with low back pain and failed back surgery syndrome underwent implantation of a SCS without complications. Ten months after implantation, one SCS lead extruded from her lower back leading to surgical removal of the leads.ResultsAfter identifying the complication of a SCS lead extruding from the patient’s back, a surgical revision was performed to remove the SCS leads but retain the implantable pulse generator (IPG) in the gluteal region. During the surgery, it was noted that the anchors were in the appropriate position, sutured and fibrosed to a deep fascial layer. There were no complications from the surgical revision and no infectious process was observed.ConclusionsWe report the occurrence and management of a rare complication of SCS lead extrusion after SCS implantation for failed back surgery syndrome. After recognition, removal of the leads with retention of the IPG was able to effectively resolve the complication. The revising procedure was well tolerated but resulted in the recurrence of the patient’s previous low back pain. We believe that knowledge of this case and its management will aid future physicians in the recognition and management of this rare complication of SCS implantation. Furthermore, as there is a paucity of literature discussing the management of lead extrusion after SCS implantation, we hope that this case report will spur additional research on the management of this complication.

scholarly journals Use of Spinal Cord Stimulator for Treatment of Lumbar Radiculopathy in a Patient with Severe Kyphoscoliosis

2008 ◽  
Vol 4;11 (8;4) ◽  
pp. 555-559 ◽  
Author(s):  
Joseph Atallah
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Failed Back Surgery Syndrome ◽  
Radicular Pain ◽  
Activity Level ◽  
Spinal Cord Stimulator ◽  
Lumbar Radiculopathy ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Technical Considerations

Spinal cord stimulation (SCS) has been a therapeutic option for chronic pain for over 40 years with a common indication being failed back surgery syndrome (FBSS). This case reports the successful implantation of a spinal cord stimulator in a patient with FBSS and kyphoscoliosis for treatment of radicular pain. Technical considerations and anatomical difficulties that may be encountered during placement with kyphoscoliosis will be discussed. This patient had failed other therapies including oral medications, epidural steroid injections, spinal surgeries, and physical and aquatic therapies. On physical examination the patient had a severely deformed lumbar spine. Careful review of the spine radiographs and CT scan revealed lead placement might be possible at the level of T12-L1 or L1-2. A Medline search did not reveal a case of kyphoscoliosis with radicular pain treated with SCS. After a successful percutaneous trial, a SCS was implanted. Fourteen weeks later, the patient reported being pain free with an increased physical activity level and opioid discontinuation. Technical considerations with kyphoscoliosis may discourage pain physicians from attempting SCS. This case illustrates that with careful selection, some of these patients may be candidates for SCS with good results. Key words: Spinal cord stimulator, spinal cord stimulation, failed back surgery syndrome, kyphoscoliosis, back pain, lumbar radiculopathy

Failed Back Surgery Syndrome: 5-Year Follow-Up after Spinal Cord Stimulator Implantation

Neurosurgery ◽  
1991 ◽  
Vol 28 (5) ◽  
pp. 692-699 ◽  
Author(s):  
Richard B. North ◽  
Matthew G. Ewend ◽  
Michael T. Lawton ◽  
David H. Kidd ◽  
Steven Piantadosi
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Failed Back Surgery Syndrome ◽  
Electrode Placement ◽  
Successful Outcome ◽  
Spinal Cord Stimulator ◽  
Long Term Outcome ◽  
Failed Back Surgery ◽  
Back Surgery

Abstract Spinal cord stimulation, in use for more than 20 years, has evolved into an easily implemented technique, with percutaneous methods for electrode placement. We have reviewed our experience with this technique in treating “failed back surgery syndrome,” and have assessed patient and treatment characteristics as predictors of long-term outcome. A series of 50 patients with failed back surgery syndrome (averaging 3.1 previous operations), who underwent spinal cord stimulator implantation, was interviewed by impartial third parties, at mean follow-up intervals of 2.2 years and 5.0 years. Successful outcome (at least 50% sustained relief of pain and patient satisfaction with the result) was recorded in 53% of patients at 2.2 years and in 47% of patients at 5.0 years postoperatively. Ten of 40 patients who were disabled preoperatively returned to work. Improvements in activities of daily living were recorded in most patients for most activities; loss of function was rare. Most patients reduced or eliminated analgesic intake. Statistical analysis (including univariate and multivariate logistic regression) of patient characteristics as prognostic factors showed significant advantages for female patients and for those with programmable multi-contact implanted devices. These results, in patients with postsurgical lumbar arachnoid and epidural fibrosis and without surgically remediable lesions, compare favorably with the results in two separate series of patients with failed back surgery syndrome, in whom 1) surgical lesions were diagnosed and repeated operation performed; and 2) monoradicular pain syndromes were diagnosed and dorsal root ganglionectomies peroformed at our institution. This suggests the need for further assessment of selection criteria, critical analysis of treatment outcome, and prospective study of spinal cord stimulation and alternative approaches to failed back surgery syndrome.

Multicolumn Spinal Cord Stimulation Lead Implantation Using an Optic Transligamentar Minimally Invasive Technique

Neurosurgery ◽  
2013 ◽  
Vol 73 (3) ◽  
pp. 550-553 ◽  
Author(s):  
Philippe Rigoard ◽  
Anh Tran Luong ◽  
Alexandre Delmotte ◽  
Mille Raaholt ◽  
Manuel Roulaud ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Failed Back Surgery Syndrome ◽  
Leg Pain ◽  
Invasive Technique ◽  
Lower Back ◽  
Lead Placement ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
New Generation

Abstract BACKGROUND: A new generation of neurostimulation surgical leads is used to increase the success of spinal cord stimulation in difficult-to-treat indications such as failed back surgery syndrome. Minimal access spinal technologies (MASTs) have previously been used for surgical lead implantation. However, only a unilateral approach was possible, causing difficulties for median lead placement, and not always preventing laminectomy. A recent MAST technique was used to implant spinal cord stimulation leads without these limitations. OBJECTIVE: To describe the MAST technique used in a pilot study. METHODS: Twenty-four consecutive patients were implanted with a multicolumn surgical lead for refractory chronic back and leg pain by using the optic transligamentar MAST technique. RESULTS: The MAST technique allowed median lead placement, facilitated visualization of the spine, and permitted transligamentar insertion that minimized scarring and muscle damage. No technique-related adverse events or lead revisions were reported. CONCLUSION: Use of a MAST approach could be useful in safe implantation of multicolumn surgical leads in difficult-to-treat, refractory lower back pain conditions such as failed back surgery syndrome.

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