Progressive Paraplegia from Spinal Cord Stimulator Lead Fibrotic Encapsulation

Abstract

Ten years after placement of a spinal cord stimulator (SCS) and resolution of pain, this patient presented with progressive paraplegia, worsening thoracic radicular pain at the same dermatome level of the electrodes, and bowel and bladder incontinence. Computed tomographic myelogram confirmed thoracic spinal cord central canal stenosis at the level of electrodes. After removal of the fibrotic tissue and electrodes, the patient had resolution of his thoracic radicular pain and a return of his pre-SCS pain and minimal neurologic and functional return. To the authors' knowledge, no studies have been identified with thoracic SCS lead fibrosis in the United States causing permanent paraplegia. Only one other case has been reported in Madrid, Spain. Patients with SCS presenting with loss of pain relief, new-onset radicular or neuropathic pain in same dermatome(s) as SCS electrodes, worsening neuromuscular examination, or new bladder or bowel incontinence need to be evaluated for complications regarding SCS implantation causing spinal stenosis and subsequent cord compression to avoid permanent neurologic deficits.

Spinal Cord Stimulator Explant and Revision Complicated by Syrinx Formation: A Case Report and Literature Review

“…There is also a reported case of cord compression from epidural fibrosis associated with percutaneously placed spinal cord stimulation electrodes [9]. There is a case report demonstrating thoracic SCS lead fibrosis causing permanent paraplegia [10]. Epidural hematoma reports have been described in context of both the removal of percutaneous spinal cord stimulator leads and also in a case with spinal cord stimulator trial lead placement in someone taking aspirin [11, 12].…”

Interfacing with the nervous system: a review of current bioelectric technologies

“…From percutaneous cranial nerve stimulation to treat chronic [35,36,75,136,142] and episodic [107,125] migraines and neuralgia, to epidural placement of leads in the dorsal root ganglion (DRG) for treatment of neuropathic pain [68], and to direct sacral anterior root stimulation to enhance bowel function post-spinal injury [117], electrical stimulation of nerves or nerve roots has been demonstrated to be a safe and efficacious clinical intervention. Although long-term repercussions of implantable neurostimulators have yet to be fully elucidated, the major shortcomings of implantable devices arise from the fibrotic foreign body response that develops following implantation, particularly following implantation within the peripheral or central nervous system [10]. Restricting the neuroprosthetic device to the epineurium can mitigate any ensuing foreign body response; however, longterm use with this approach can induce histological changes (e.g., fibrosis, perineural thickening, decrease in axon myelination) at the site of electrode lead placement [6].…”