Intrathecal Bleed Following Percutaneous Spinal Cord Stimulator Trial Lead Placement

Abstract

An intrathecal bleed is an exceedingly rare, yet potentially devastating consequence of accessing the epidural space for lead placement during a spinal cord stimulator trial. We present a case of radiologic evidence of intrathecal blood products and the neurologic consequences thereof following a percutaneous spinal cord stimulator trial. A 34-year-old man with a primary diagnosis of failed back surgery syndrome underwent percutaneous spinal cord stimulator lead placement. During the trial, the patient experienced paresthesia with initial right-side lead placement at T12-L1. The lead and needle were removed and placed at L1-2 where the patient did not report any problems. The patient reported right calf pain in the postanesthesia care unit following the trial that improved with intravenous hydromorphone. However, following discharge the patient experienced worsening dysesthesia with edema of the right lower extremity to the calf. Magnetic resonance imaging of the lumbar spine confirmed the presence of blood products within the intrathecal space. Spinal cord stimulator placement may be viewed as a safe and effective treatment modality despite the incidence of several neurologic, mechanical, and biologic complications. A few case reports discuss the occurrence of spinal epidural hematoma formation but none present a case of an intrathecal bleed following percutaneous spinal cord stimulator lead placement. This case report highlights the need to further elucidate the incidence of neurologic sequelae after spinal cord stimulator placement. Key words: Spinal cord stimulation, antiplatelets, anticoagulation, intrathecal bleed, complications, failed back surgery syndrome