Spinal cord stimulation-induced gastroparesis: A case report

Abstract

Background: Spinal cord stimulation (SCS) involves the utilization of an implantable neurostimulation device, stereotypically used in the treatment of patients with chronic neuropathic pain. While these devices have been shown to have significant clinical benefits, there have also been documented potential complications, including the risk of infection, fractured electrodes, electrode migration, and lack of symptom improvement. In addition, there has been minimal documentation on gastrointestinal (GI) side effects after SCS implantation. Case Description: A 42-year-old patient with chronic axial and radicular neuropathic pain in her back and left leg status post multiple lumbar surgeries underwent implantation of an open paddle lead in the T8–T9 region. After the procedure, the patient endorsed a 50% decrease in pain at the 6-week follow-up with no further concerns. However, at the 18 months follow-up, the patient endorsed severe constipation when the SCS was turned on, leading to subsequent evaluation by gastroenterology, motility studies, and a thorough bowel regimen. Symptoms persisted, and the patient ultimately opted for the removal of the SCS implant at 21 months after the initial surgery. Conclusion: While the exact mechanism behind the GI side effects endorsed in this patient is unknown, current literature postulates a variety of theories, including a SCS-induced parasympathetic blockade of the GI tract. Further, investigation is needed to determine the exact effects of SCS on the GI tract.

Chronic Constipation Ameliorated by Thoracic Spinal Cord Stimulation

“…Sporadic cases documented that SCS is associated with gastrointestinal symptoms (Table 1 ). Thoracic SCS is associated with both diarrhea [ 6 ] and constipation [ 7 , 9 ], which suggests that SCS changes sympathetic/parasympathetic balance according to stimulation parameters (frequency, intensity, polarity, and targeted area). To the best of our knowledge, there are no previous reports of gastrointestinal symptoms associated with lower thoracic SCS.…”

“…SCS is effective for visceral pain when the midline dorsal columns of thoracic levels are targeted [1][2][3][4]. Although transient and reversible, studies have reported SCS-associated unfavorable gastrointestinal symptoms such as nausea, diarrhea, or constipation [5][6][7][8][9]. While these symptoms suggest autonomic neuromodulation of gastrointestinal systems, therapeutic effects have been demonstrated only for the treatment of irritable bowel syndrome through T5-8 stimuli [10][11][12].…”