Prolonged Severe Abdominal Pain Following Spinal Cord Stimulator Implantation: A Case Report of Post-Operative Spinal Cord Stimulator Thoracic Radiculopathy

Abstract

The use of neuromodulation, specifically spinal cord stimulator, has gained popularity in the management of chronic pain syndromes. Some indications for spinal cord stimulator placement include chronic pain arising from complex regional pain syndrome (CRPS), neuropathy, and post-laminectomy syndrome. With placement of spinal cord stimulator, there have been poorly described cases of post-operative thoracic radiculopathy as a potential complication. This case report describes a patient with prolonged severe thoracic radiculopathy after undergoing spinal cord stimulator paddle lead placement. The patient is a 52 years old female with a history of worsening low back and leg pain not relieved by conservative measures and back surgeries. She underwent successful percutaneous SCS trial with greater than 80% relief of her symptoms; with subsequent implantation of SCS, paddle lead. In the immediate post-operative period, the patient reported good relief of leg pain with spinal cord stimulator turned on. However, she complained of severe, achy bandlike thoracic and abdominal pain. Of note, there were no intraoperative events. Her pain was minimally relieved with medication management. All laboratory work, abdominal and chest radiographs as well endoscopy was negative. With good relief of leg pain with SCS, she declined removal of the paddle lead. There are a few case studies that have described thoracic radiculopathy after spinal cord stimulator placement. In those cases, pain gradually improved within a short duration; and or after removal of the device. This particular patient had prolonged steady 9-10/10 abdominal pain that was not amenable to conservative treatment. Although a rare phenomenon, it is important to know that persistent abdominal pain can be a result of thoracic neurological injury during SCS lead placement.