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- Mar 17, 2011
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I had an interesting case, 70yo m chronic LBP, no prior surgery. Had tried injections, PT, meds without significant relief over the past few years. No blood thinners. We elected to trial SCS. Lumbar/thoracic imaging showed some diffuse but mild disc bulging without stenosis.
Very straightforward trial, easy access T12/L1, threaded both leads to T7. Leads were midline and dorsal throughout the trial. No discomfort or barriers at all. After securing the leads the pt reported sensation loss below the waist. He was able to move his legs but very ataxic and he had no sense of leg movement. When he did resist, strength was full but not sustained. Totally asensate to light/deep palpitation.
I immediately removed both leads and contacted EMS for transport to ED. By the time they arrived sensation was improving but not back to normal. I spoke to the ED to give them a heads up, obtained a stat CT on arrival lumbar/thoracic. Negative image. I joined them in the ED 20 min after arrival (connect to my clinic). By that time exam had completely normalized and he was ambulating in the ED. His primary concern was when he could try stim again (!).
I’m updating his MRIs this week (they are only 3 months old), and discussed with NSG doing a surgical trial.
I think it must have been a temporary compressive thoracic myelopathy from the leads, but odd given unremarkable imaging and trial. Has anyone else had this happen? Any other SCS trial issues to learn from?
Very straightforward trial, easy access T12/L1, threaded both leads to T7. Leads were midline and dorsal throughout the trial. No discomfort or barriers at all. After securing the leads the pt reported sensation loss below the waist. He was able to move his legs but very ataxic and he had no sense of leg movement. When he did resist, strength was full but not sustained. Totally asensate to light/deep palpitation.
I immediately removed both leads and contacted EMS for transport to ED. By the time they arrived sensation was improving but not back to normal. I spoke to the ED to give them a heads up, obtained a stat CT on arrival lumbar/thoracic. Negative image. I joined them in the ED 20 min after arrival (connect to my clinic). By that time exam had completely normalized and he was ambulating in the ED. His primary concern was when he could try stim again (!).
I’m updating his MRIs this week (they are only 3 months old), and discussed with NSG doing a surgical trial.
I think it must have been a temporary compressive thoracic myelopathy from the leads, but odd given unremarkable imaging and trial. Has anyone else had this happen? Any other SCS trial issues to learn from?