Cervical Spinal Cord Stimulator Malfunction Secondary to Lead Fracture.

Background: Spinal cord stimulation (SCS) is commonly used in the cervical spine to manage chronic intractable pain. However, complications can include lead displacement, lead migration, and lead fracture. CASE REPORT 1: The first case is of a 67-year-old woman who underwent spinal cord stimulator implantation in 2009 for the treatment of complex regional pain syndrome (CRPS). The device used was a Medtronic Restore system with an Octad 1×8 single lead array, and the battery was replaced in 2021. In December 2023, the patient began experiencing new-onset symptoms including dizziness, headaches, and balance disturbances. Due to these emerging neurological symptoms and the necessity for magnetic resonance imaging (MRI), the SCS system was explanted. CASE REPORT 2: The second case is of a 78-year-old woman who underwent spinal cord stimulator implantation in 2011 for the treatment of CRPS. The system used was a Medtronic RestoreUltra with an Octad 1×8 dual lead array. In 2020, the battery was replaced with a Medtronic Intellis pulse generator due to end-of-life. In 2021, following a motor vehicle accident, the patient began experiencing electric shock-like sensations whenever the spinal cord stimulator was activated. A system interrogation was performed in 2022, which failed to resolve the issue. Due to the persistent uncomfortable sensations and lack of therapeutic benefit, she requested removal of the system, which was explanted in May 2025. Post-explantation imaging revealed that the distal electrode of one lead remained in the cervical spine.

Conclusion: These two case reports highlight unusual presentations of cervical spinal cord stimulator lead fracture with or without loss of stimulation effectiveness. However, in the first case, despite the continued functionality of the device, the patient developed unexplained neurological symptoms and required MRI imaging. These symptoms improved following device removal, even though a portion of the electrode remained in place. In the second case, stimulation produced uncomfortable electrical sensation requiring electrical stimulation. During the surgical procedure, post-explantation imaging revealed that the top electrode remained in the cervical spine, which in both cases was not identified until after explantation.