Disclosures: Thereseann M. Huprikar, DO: No financial relationships or conflicts of interest

Case Description: The patient had SCS trial leads placed without complication at another clinic, and he reported improvement of his low back and radicular pain symptoms during the trial. At the time the trial leads were pulled, he developed acute onset bilateral lower extremity numbness and weakness, requiring transfer to the emergency department. Evaluation included magnetic resonance imaging (MRI) of the thoracic spine showing multilevel degenerative changes with moderate-severe central canal stenosis at T9-T10 with cord signal change at that level.

Setting: A private outpatient clinic

Patient: An 85-year-old male who underwent thoracic spinal cord stimulator (SCS) trial for chronic low back pain and lumbosacral radiculopathy. Assessment/

Results: At the time of our evaluation 3 months later, he continued to have 4/5 strength diffusely in bilateral lower extremities, bowel incontinence, and gait impairment. He went on to have surgical decompression, and subsequently had minor neurologic and functional improvement.

Discussion: Although considered to be a generally safe procedure, SCS trial and permanent lead placement does have known risks. The most common complications include lead migration, superficial infection, and dural puncture. There have been rare neurologic complications reported. Most were due to epidural or subdural hematomas, or epidural abscess. To our knowledge, this is the first report of spinal cord injury associated with SCS trial lead removal due to pre-existing thoracic stenosis and without the presence of other space occupying lesion.

Conclusion: Obtaining a pre-procedure thoracic spine MRI is not currently standard of care for thoracic spinal cord stimulator trial lead placement. In patients who may be at risk of thoracic spine stenosis, MRI of the thoracic spine should be considered prior to SCS trial.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/thoracic-spinal-cord-injury-after-spinal-cord-stimulator-trial-lead-removal-in-a-patient-with-pre-existing-thoracic-stenosis-a-case-report/