Epidural Lipomatosis as a Cause for High Impedance Values During a Spinal Cord Stimulator Trial

Abstract

A spinal cord stimulator (SCS) trial often involves the percutaneous placement of trial leads in the epidural space and has been used to treat a variety of chronic pain conditions, including complex regional pain syndrome I and II, failed back surgery syndrome, radi culopathy, postherpetic neuralgia, ischemic chest and limb pain, spinal cord injury, and phantom limb pain [1,2]. Spinal epidural lipomatosis (SEL) is seldom considered a contraindication for an SCS trial. In this Clinical Pearl, we present the case of a patient who did not respond to a percutaneous SCS trial and who had abnormally high impedance levels at a spinal level that directly correlated with the presence of a large area of thoracic SEL, which was discovered on subsequent thoracic magnetic resonance imaging (MRI).