SCS problem

Discussion in 'Pain Medicine' started by Mister Mxyzptlk, 09.29.14.

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  1. Mister Mxyzptlk

    Mister Mxyzptlk 10+ Year Member

    Joined:
    05.16.06
    Messages:
    4,154
    Location:
    Yewston, TX
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    Attending Physician
    I have a lady with RSD of the left foot. We implanted a single lead SCS a few months ago with excellent coverage. In late July/early August we did 2 LSBs for recurrent edema and temperature instability with increased pain. She did well. About 3 weeks after that she reported pain in the left lumbar area whenever she got paresthesias in her foot.

    The pain is around where the anchor is but palpation of the area, including the anchor, doesn't hurt.

    I interrogated the IPG and all the impedances were good.

    I tried changing rate, PW, and all sorts of electrode configurations but no matter what, she always had back pain whenever we could produce paresthesias in the foot.

    There is a steep threshold for stim. At 3.0 she feels nothing, but at 3.2 she has foot paresthesias and back pain. It doesn't change when I have her flex.

    I xray'd the lead, which is in the same position as implant. I xray'd the IPG and the lead looks to be well-seated.

    This behaves kind of like a boot leak but it's a single lead connected directly into the IPG. If I had a connection in the left lumbar area I'd do a revision.

    My wild guess is that maybe I bagged the lead when I did the LSB and it took a few weeks to develop a leak but that's a stretch with no impedance changes.
     
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  3. SSdoc33

    SSdoc33 7+ Year Member

    Joined:
    04.23.07
    Messages:
    4,358
    Status:
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    i dont think the LSB messed up anything. i dont have an answer for you, but the shots didnt do it.....
     

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