A Report of Paraparesis Following Spinal Cord Stimulator Trial, Implantation and Revision

Background: Spinal cord injury has been reported as a rare complication of spinal cord stimulation (SCS). A review of the literature shows a very low incidence of neurological injury after spinal cord stimulation trial, implantation and revision. The most common reported complication is equipment failure without neurologic injury. The incidence of spinal cord injury after SCS trial, implantation and revision is unknown. There have been limited reports of neurologic injury secondary to dural puncture, infection, cord contusion, actual needle penetration of the spinal cord and epidural hematoma. Study Design: A report of 4 cases. Objective: To report 4 occurrences of neurological complication after spinal cord stimulator implantation. Methods: Four patients are presented who were admitted to an acute spinal cord rehabilitation hospital over a 4-month period. All 4 patients presented with paraparesis after spinal cord stimulator trial or implantation. One of the injuries is secondary to cord contusion, while the other 3 are secondary to cord compressions. Two of these compressions are due to epidural hematomas and one secondary to implantation in the setting of broad based thoracic disc herniations. The clinical cases are presented as well as a review of the literature. Results: All 4 patients had the electrodes and neurostimulators successfully removed prior to their acute rehabilitation admissions. At discharge from acute inpatient rehabilitation, one patient continued to experience complete paraplegia, 2 patients had incomplete paraparesis and one had fully recovered all of his neurologic function. Conclusion: SCS is considered a safe procedure. Further investigation into the true incidence of neurologic injury after SCS is warranted. Key words: spinal cord stimulation, spinal cord injury, rehabilitation, pain, epidural hematoma, cord contusion, disc herniation