Disclosures: Jessica N. Buttinger, MS: No financial relationships or conflicts of interest

Case Diagnosis: Spinal Cord Injury secondary to epidural hematoma in the setting of spinal cord stimulator placement, Incomplete T9 AIS-B equivalent.

Case Description: A 78-year-old male with medical comorbidities including chronic low back pain and cervical decompression and fusion, presents with sudden onset lower extremity weakness, paresthesias, and an abnormal sensation in his lower extremities. He had a spinal cord stimulator placed at the T8-T9 level two days prior without any intraoperative or postoperative complications noted. He subsequently underwent emergent decompression of an epidural hematoma at the T8 level with a laminectomy. He remained stable and was transferred to the inpatient rehabilitation unit where he was found to have a T9 spinal cord injury.

The patient has flaccid tone in the bilateral lower extremities. Strength is 4/5 in bilateral upper extremities and 0/5 in bilateral lower extremities. Reflexes are 2+ in bilateral upper extremities and absent in bilateral lower extremities. Sensation to light touch, pinprick, sharp dull, and 2-point discrimination, is grossly diminished bilaterally at the level of T9. Babinski is absent bilaterally. Poor anal tone, but anal wink present.

Setting: Community-based hospital

Assessment/Results: Two weeks status post-stimulator placement and spinal cord injury, physical exam remains grossly unchanged.

Discussion: Spinal cord stimulator therapy is reported as a safe and reversible modality in treating chronic pain. Most complications from this procedure are minor such as lead migration, infection, or pain near or at the surgical site. However, a spinal cord injury is the rarest and most feared sequela. Cameron 2004, reported the risk of epidural hematoma development to be 0.3% and subsequent paralysis risk to be 0.03%.

Conclusion: Spinal cord injury is an uncommon, but devastating complication from spinal cord stimulator placement. More work must be done to determine which candidates may be predisposed to such an injury or to further elucidate the precipitating factors to this feared sequela.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/uncommon-complication-status-post-spinal-cord-stimulator-placement/