Management of Pulmonary Emboli During a Spinal Cord Stimulator Trial: A Case Report

Abstract

Background: Neuromodulation has been used in the management of chronic pain for well over 30 years and is becoming increasingly relevant in the face of the ongoing opioid epidemic. Although this therapy continues to provide pain relief and improvement in function to patients with a wide variety of pathologies, several complications have been described ranging from lead migration to development of a granuloma causing cord compression. Although not described in the literature, a pulmonary embolism can be one of the rare complications of a spinal cord stimulation procedure, and when it happens during the trial period of spinal cord stimulation, it involves significant challenges in the clinical management of anticoagulation in the patient. Case Report: We present a case in which a patient developed bilateral pulmonary emboli (PE) during the trial phase of spinal cord stimulation. The patient did have a prior history of PE, had an inferior vena cava filter in place, and was on anticoagulation, which was held as per the current American Society of Regional Anesthesia guidelines prior to the spinal cord stimulator (SCS) trial. Conclusion: A pulmonary embolus is a possible complication from an SCS trial, especially in patients with preexisting thromboembolic risk factors. Management must involve multidisciplinary care focused on balancing the risks of thrombosis with those from a potential epidural hematoma at the time of lead removal. Key words: Spinal cord stimulation, pulmonary embolus, spinal cord stimulator complications, neuromodulation, venous thromboembolism, SCS trial, VTE, PE