23rd Annual Pain Medicine Meeting 2024

Bilateral Multi-Fragment Percutaneous Lead Fracture in Implanted Spinal Cord Stimulator

•Our case involves a 44-year-old male with a history of lumbosacral degenerative disc disease, lumbar radiculopathy status post L4-S1 fusion, type 2 diabetes, mild cognitive impairment, obesity and schizoaffective disorder

•He presented with worsening lumbar back pain and lower extremity radiculopathy after placement of a SCS

•The initial implantation was successful with bilateral leads inserted at the T11-12 interspace via the left paramedian approach and advanced to the upper T8

•The patient reported over 80% relief in the weeks following the placement

•Three months later, he reported worsening pain and loss of relief from the SCS. He denied infection, bleeding, new muscle weakness, bowel or bladder incontinence and saddle anesthesia

•The SCS was unable to be reprogrammed secondary to a high impedance, and lead fracture was suspected. Only three contacts of 16 total were functional

•The decision was made for a lead revision

•A left paramedian incision was made, multiple lead fractures within each lead were noted. One lead was easily removed, and two fractures were visualized within the lead

•The other lead was gently pulled back and examination revealed the metallic lead in the lumen was discontinuous and the clear sheath extended several centimeters into the fascia making intact removal unlikely

•The incision was therefore extended cephalad and once the portion of the lead with metallic material within it was visible, this was grasped with a Debakey and gently pulled out with the lead intact

Approximately 5 different lead fractures were noted on the lead

23rd Annual Pain Medicine Meeting 2024

BILATERAL MULTI-FRAGMENT PERCUTANEOUS LEAD FRACTURE IN IMPLANTED SPINAL CORD STIMULATOR (SCS): A CASE REPORT

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