Posterior Cord Syndrome After Spinal Cord Stimulation Electrode Lead Insertion: A Case Report

Korean J Neurotrauma, 2022 · DOI: https://doi.org/10.13004/kjnt.2022.18.e59 · Published: October 18, 2022

Spinal Cord Injury Neurology Pain Management

Simple Explanation

This case report describes a rare complication following spinal cord stimulation (SCS) for chronic neuropathic pain after spinal cord injury. The patient experienced a loss of proprioception, known as posterior cord syndrome, immediately after the SCS electrode lead insertion. SCS is a treatment option for chronic neuropathic pain, but it carries risks such as hardware issues, infection, and, rarely, neurological deficits. This case highlights the importance of considering potential complications even with relatively safe procedures like SCS. The patient's proprioception improved after the SCS lead was removed. This case emphasizes the need for careful monitoring and prompt intervention when neurological complications arise following SCS implantation.

Study Duration

Not specified

Participants

A 42-year-old man

Evidence Level

Level 4: Case Report

Key Findings

1
The patient developed posterior cord syndrome, specifically a loss of proprioception, immediately after the insertion of a paddle-type SCS electrode lead.
2
Electrophysiological evaluation (SSEP) confirmed dysfunction of the somatosensory pathway in the lower extremities, supporting the diagnosis of posterior cord syndrome.
3
The patient's proprioceptive sensation recovered approximately 6 months after the removal of the SCS lead.

Research Summary

This case report describes a patient who developed posterior cord syndrome, characterized by decreased proprioception, immediately after spinal cord stimulation (SCS) electrode lead insertion for chronic neuropathic pain following a spinal cord injury. The patient's symptoms did not improve with conservative management, leading to the removal of the SCS lead. Subsequent electrophysiological studies confirmed the presence of somatosensory pathway dysfunction. The patient's proprioception gradually recovered after the SCS lead was removed, highlighting the reversibility of this specific complication in this case.

Practical Implications

Careful Patient Selection

Thoroughly evaluate patients for pre-existing conditions (e.g., spinal stenosis) that may increase the risk of neurological complications following SCS.

Intraoperative Monitoring

Consider using intraoperative evoked potentials to monitor spinal cord pathway integrity during SCS lead placement.

Prompt Intervention

Be vigilant for neurological changes postoperatively and consider early removal of the SCS lead if significant deficits arise.

Study Limitations

1
Single case report limits generalizability.
2
Lack of postoperative imaging (MRI) to definitively rule out hematoma or ischemia.
3
Exact mechanism of posterior cord syndrome could not be definitively determined.

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