Disclosures: Alexander Shustorovich, DO: Nothing to disclose

Case Description: Percutaneous spinal cord stimulator trial for treatment of Failed Back Surgery Syndrome and associated bilateral gluteal neuropathic pain. Prior imaging was reviewed and was evident for lumbar fusion spanning T10-S1. Due to likelihood of significant scar tissue a more proximal entry point (T10) was used to avoid hardware and scar tissue. The patient was positioned prone on the fluoroscopy table and prepped and draped in the usual sterile fashion. Local anesthetic was used for skin and subcutaneous tissue. Using a right paramedian approach, a 14-gauge Tuohy needle was advanced to enter the epidural space by loss of resistance technique. No resistance was met on advancement of first lead, but positioning difficulty was noted. Upon slight retraction to reposition prior to re-advancing, separation of distal electrode from main lead was seen. There was no resistance on retraction of the lead. Fragment position established by fluoroscopy at about T8 level. The procedure was aborted. Vital signs were stable, and no new neurological deficits noted. Patient was transferred to ED for urgent evaluation.

Setting: Ambulatory Surgical Center

Patient: 62-year-old female with failed back surgery syndrome.

Assessment/Results: Imaging (CT thoracolumbar spine) in the ED (day 0) revealed a 5mm metallic density in the right posterior epidural space at the level of T7. She was admitted for observation and discharged the following day after care-plan was delineated by her neurosurgeon. She ultimately had thoracic laminectomy on day 38 with removal of retained electrodes and placement of paddle leads. Subsequent implantation of generator on day 41. Patient reported improved lumbar and gluteal pain on 1-month follow up with Interventional Spine.

Discussion: To the best of our knowledge, this is the second reported case describing electrode fracture during percutaneous trial lead placement.

Conclusion: Although rare, electrode fracture during the time of placement must be considered as a potential complication.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/spinal-cord-stimulator-electrode-fracture-during-percutaneous-trial-lead-placement-a-case-report/