Reversible thoracic myelopathy after surgical decompression and removal of paddle neurostimulator lead and encasing fibrosis: Technical video case report

摘要

Spinal cord stimulation is an established and safe technique for the treatment of medically refractory and chronic pain. Electrodes or paddle leads can be used for stimulation. Most complications reported are related to hardware insertion, and the devices are otherwise usually well tolerated. There have been several reports of epidural fibrosis formation around the leads with varying degrees of spinal cord compression, but no descriptions of the technical treatment of these lesions, or of patient outcome after surgery. We describe the interesting case of an 85-year-old woman with a thoracic spinal cord stimulator implanted 8years prior to presenting with a 5-month history of bilateral lower extremity weakness, and myelopathic signs on exam, as well as intractable thoracic pain. Her CT Myelogram revealed significant epidural fibrosis around her thoracic paddle lead with compression of her spinal cord. After surgical removal of the lead and the surrounding fibrosis, she recovered her lower extremity function and her thoracic pain improved. This is an uncommon complication of spinal cord stimulator lead or paddle placement, but can carry a clinically significant impact. Unusual fibrotic scar formation around paddle or percutaneous leads should be suspected in patients experiencing worsening axial pain with decreasing relief from their spinal cord stimulator, especially in the context of progressive myelopathic symptoms. Highlights ? Epidural fibrosis formation is a potential complication after implantation of spinal stimulation leads ? Removal of the implant and the fibrotic scar is necessary when compression results in myelopathy ? Extinction may be a sign of scar formation and warrant a CT myelogram especially in the setting of worsening myelopathy.