Erroneous intramedullary placement of spinal cord stimulator: A case report and review of the literature.

Abstract

Background: Spinal cord stimulation is a common treatment for patients with medically refractory chronic neuropathic pain. Before permanent implantation of spinal cord stimulation, patients will undergo a percutaneous trial to ensure the efficacy of the treatment modality and determine the optimal location of placement. While complications from this procedure are rare, there are reports in the literature of infection, epidural hematoma, and even paralysis. There are few reports of percutaneous leads tracking through the spinal cord itself, and subsequently, few reports of management should such a complication take place. Herein, we provide an example of such a phenomenon with no significant postoperative complications, morbidity, or mortality.

Case description: A retrospective chart review was completed utilizing the electronic medical record. Data gathered included patient demographics, oncological history, medications, imaging, and operative reports. This is a 64-year-old male with a history of with a history of a traumatic brachial plexus avulsion and right upper extremity amputation at the shoulder after a motorcycle accident approximately 20 years prior presented to our institution with left upper extremity paresthesias, gain imbalance, and urinary incontinence after a permanent percutaneous spinal cord stimulation lead was placed from an outside institution. The patient was found to have the lead tracking through the intramedullary space of his spinal cord. The patient was taken to the operating room for removal of the lead and had no significant complications during his postoperative course.

Conclusion: There is a paucity of literature regarding the removal of an intramedullary percutaneous spinal cord stimulator lead; herein, we present such a case.