Session Time: 12:30pm-2:00pm
Location: Research Hub - Kiosk 7
Disclosures: Vishal Bansal: Nothing to disclose
Case Description: This patient was referred by community pain management physician with persistent, intractable pain and new onset of neuro deficits during Wireless Spinal Cord Micro-Stimulator trial. He was a suboptimal surgical candidate for further invasive spinal procedures; limiting certain proposed interventions. However, the patient was a good candidate for a Stimwave Spinal Cord Stimulator (SCS); an external spinal cord micro-stimulator that programs wireless electro-stimulatory leads. During the trial two leads were placed to the level of T7 in the dorsal epidural space. Leads were anchored with adhesive at the insertion site. Two days after post-procedure, he returned to the pain management clinic with new-onset severe intractable radicular pain and myelopathic findings. Further evaluation of pain showed cephalad migration of electro-stimulatory leads through the skin to anterior epidural space at the T1 level.
Setting: Tertiary care hospital, Pain management, Neurosurgery.
Patient: A 61-year-old man with history of chronic low back pain due to failed back surgery syndrome; post L4-S1 lumbar fusion.
Assessment/Results: CT scan revealed electro-stimulatory lead had migrated anterior to the level of T1. The micro-stimulator array was completely lost in the epidural space. Emergent surgery was required due to the neurological findings and imminent risk of infection. No residual deficits or infection were seen post-operatively.
Discussion: This case highlights a novel complication unique to wireless spinal cord stimulators not commonly observed with implanted spinal cord stimulators. Migration was likely caused by flexion, extension and sub-optimal fixation. Although lead migration is a common risk with SCS trials, no documented cases have been reported of complete loss of the lead into the epidural space during trial period.
Conclusion: It is imperative for further research and development of a more robust anchor component to mitigate the potential complications from wireless lead migration and loss. Extensive flexion, and extension restrictions need to be reinforced during the trial period.
Level of Evidence: Level V
To cite this abstract in AMA style:Bansal V, Mehta A. Wireless Spinal Cord Micro-stimulator Complete Migration into the Epidural Space to T1 During Trial Period Causing Cord Irritation: A Case Report [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/wireless-spinal-cord-micro-stimulator-complete-migration-into-the-epidural-space-to-t1-during-trial-period-causing-cord-irritation-a-case-report/. Accessed September 20, 2021.
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