Spinal Cord Stimulator Implantation with Immediate Post-Op Paraplegia: A Case Report

Case Diagnosis: A 67-year-old woman with chronic back pain, lumbar stenosis, and radiculopathy status post multiple prior surgical interventions developed paraplegia following spinal cord stimulator (SCS) implantation, a rare complication.

Case Description or Program Description: The patient had a 23-year history of lower back and leg pain from a work-related injury. She underwent multiple unsuccessful spinal surgeries and developed urinary incontinence, requiring a bladder stimulator. After a successful SCS trial at T7/T8 level with 70 percent pain relief, she underwent permanent implantation with paddle placement at T7/T8. Immediately post-operation, she experienced bilateral lower extremity paralysis. An MRI revealed spinal canal stenosis from T7-T9 with cord compression, necessitating emergency removal of the stimulator lead and generator.

Setting: Acute Hospital, Long Term Acute Care Hospital (LTACH)

Assessment/Results: The patient was transferred to an LTACH for acute inpatient rehabilitation where she received an intense interdisciplinary treatment program. The patient experienced significant improvement, particularly in the strength of her left lower extremity. By the time she was discharged, she had made notable progress in her activities of daily living (ADLs) and was able perform some at a supervision level. She became proficient in slide-board transfers with close supervision and learned to independently manage her bowel program. She was discharged at a wheelchair-level and was classified as T7 AIS C.

Discussion (relevance): This case represents one of a few reports of immediate post-operative paraplegia resulting from SCS implantation. A retrospective study indicates that 0.42% of all SCS implantations result in spinal cord injury, with an increased risk in patients who have had cervical or thoracic stenosis within the past year.

Conclusions: SCS offers hope for severe pain with the chance of an improved quality of life. However, the rare risk of paraplegia requires physicians to discuss this possibility and be prepared to ensure access to acute inpatient rehabilitation to address physical, emotional and psychological needs.