Disclosures: Richard Thai, DO: Nothing to disclose

Case Description: A 63-year-old female with cervical radiculopathy and prior fusion at C4-C7 underwent spinal cord stimulator implantation at the level of C7-T1 with some technical difficulty noted. After the procedure, the patient developed severe burning pain and weakness in her right lower extremity. The patient was promptly admitted to the hospital and MRI of the cervical spine showed abnormal increased T2 signal at C7-T1, consistent with cord edema. As her condition stabilized, she was transferred to an inpatient rehabilitation facility for further management. On admission, an International Standards for Neurological Classification of Spinal Cord Injury exam was performed, classifying her as T2 AIS D. During her inpatient rehabilitation stay, she made significant functional gains and was discharged safely home.

Setting: Outpatient and Inpatient

Patient: 63-year-old female

Assessment/Results: MRI cervical spine: Focal area of cord edema at the level of C7-T1

Discussion: Spinal cord stimulators are often utilized for patients with severe refractory pain. The site of entry for implantation varies widely among practitioners, as illustrated by one retrospective study. Looking at 24 patients, researchers identified 13 different points of entry, with the level of T7-T8 being most common (6). While every patient is unique and specific considerations should be taken, the cervical region is technically difficult due to anatomic variances and narrower epidural space. One case series of 28 patients used a retrograde approach at the level of C0-C1 to target the cervical region and reported low complication rates. Future investigations may look at spinal cord stimulator points of entry and complication rates to identify best practices, particularly in the cervical region to improve outcomes.

Conclusion: Spinal cord stimulation is a reasonable treatment option for patients with refractory pain. The procedural technique can vary widely among practitioners, particularly in the cervical region, and further work can be done to identify best practices and improve patient outcomes.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/spinal-cord-stimulator-implantation-resulting-in-spinal-cord-injury/