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Thoracic Radiculopathy Following Spinal Cord Stimulator Placement: Case Series

Authors

  • Antonios Mammis MD,

    1. Department of Neurological Surgery, UMDNJ-New Jersey Medical School, Newark, NJ, USA
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  • Christopher Bonsignore DO,

    1. Department of Neurosurgery, Harvey Cushing Institute of Neurosciences, Hofstra University School of Medicine, North Shore University Hospital, Manhasset, NY, USA
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  • Alon Y. Mogilner MD, PhD

    Corresponding author
    1. Center for Neuromodulation, Department of Neurosurgery, New York University Langone Medical Center, New York, NY, USA
    • Address correspondence to: Alon Y. Mogilner, MD, PhD, Center for Neuromodulation, Department of Neurosurgery, NYU Langone Medical Center, 530 First Avenue, HCC-3C, New York, NY 10016, USA. Email: alon.mogilner@nyumc.org

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  • There was no financial support for the creation of this manuscript.
  • This is an original work and has not been previously published in whole or in part. The above-mentioned authors all contributed to this work.
  • The authors disclose the following:
  • Alon Y. Mogilner receives grant support and consulting fees from Medtronic Neurological, and has received grant support from St. Jude Medical and consulting fees from Boston Scientific. Drs. Mammis and Bonsignore disclosed no conflicts of interest.
  • Conflict of Interest: The authors reported no conflict of interest.

Abstract

Objective

The clinical entity of thoracic radiculopathy following spinal cord stimulator (SCS) placement has not been previously described.

Materials and Methods

A retrospective review of prospectively acquired data on 172 patients, having undergone thoracic SCS placement at our institution, was performed. In addition, four patients were implanted at outside institutions, and were referred for revision. We examine our early experience with placement of thoracic SCS in surgically treated patients with chronic pain and 15 associated specific postoperative radicular pain complications along respective thoracic dermatomes. We postulate that preexisting thoracic spinal pathology affords less compliance in the placement of larger paddles, and subsequent radicular pain in a band-like abdominal fashion.

Results

A syndrome of thoracic radiculopathy, presenting as intractable lower thoracic or abdominal wall pain occurring in the immediate postoperative period, was identified in 15 patients. These patients subsequently underwent revision surgery, with either a more extensive laminectomy to further decompress the dorsal nerve roots or lead removal, both of which resulted in near immediate relief of symptoms.

Conclusions

Thoracic radiculopathy may occur following SCS paddle lead placement. This clinical syndrome is characterized by its immediate postoperative development, band-like thoracic or abdominal pain pattern, severe pain that both overwhelms the incisional pain and is refractory to medications, and absence of motor deficit. The lateral placement of paddle leads increases the risk of radicular symptoms. Preoperative thoracic spine magnetic resonance imaging may be helpful in identifying patients who may be susceptible to this syndrome.

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