Presentations

Abstract

Introduction: Spinal cord stimulation (SCS) is a neuromodulation technique widely used to treat various types of chronic pain, including failed back surgery syndrome (FBSS) and complex regional pain syndrome (CRPS). SCS involves placing electrical leads into the epidural space, with both percutaneous and open implantation techniques available. Despite its benefits, SCS carries a significant risk of complications, with lead migration being one of the most common. This case report discusses a rare complication of SCS-lead migration resulting in spinal cord hemisection and Brown-Séquard syndrome in a 57-year-old male patient.

Case Information: 57-year-old male with a history of chronic pain, SCS replacement two months earlier, and elevated PSA s/p MRI one month earlier presented to the ED with thoracic and abdominal pain and LLE weakness. Patient noted he initially felt "funny" after his MRI but ignored the feeling. Strength to the LLE was 0/5. CT imaging revealed displacement of the SCS leads. During surgery, an abscess was found and drained, and the SCS was removed. The patient was treated with intravenous vancomycin for MRSA and discharged to a skilled nursing facility with no improvement in the left leg and new sensory deficits in the right leg. Follow-up imaging showed spinal cord damage at T8-T9, consistent with Brown-Séquard syndrome. The patient was referred to PM&R for worsening spasticity and is now undergoing pain management with an intrathecal pain pump.

Discussion/Clinical Findings: Neurological injury from Spinal Cord Stimulation (SCS) is a rare but severe complication, potentially leading to paralysis and other deficits. Causes include direct trauma during lead placement, hematomas, abscesses, or lead migration. MRI safety is critical, as interactions with the static, RF, and pulsed gradient fields can induce lead migration, heating, or nerve stimulation. We initially had thought that the leads migrated secondary to static magnetic field of the patient's MRI, but the IPG and leads were found to be conditional to the MRI parameters. The more likely cause of the migration was from mechanical force from a deep abscess found posterior to the leads, that resulted in hemisection of the spinal cord and Brown-Sequard Syndrome, supported by the timeframe between the MRI and symptoms. The case underscores the importance of careful patient selection, meticulous surgical technique, and prompt recognition and management of complications.

Conclusion: This case highlights the potential severity of SCS complications, particularly lead migration leading to spinal cord injury. Clinicians should be vigilant in monitoring patients post-implantation, especially those with risk factors for lead migration, and consider early intervention to prevent serious outcomes.