Introduction: Spinal cord stimulators (SCS) have been around since the late 1960s and have increasingly been utilized for numerous conditions that have a failed medical management. Chronic neuropathic pain, including complex regional pain syndrome, is one of the most common indications for SCS trial and implantation. Complications from granuloma formation after SCS implantation are incredibly rare but have been reported.
Methods: Here we present a case of a 52-year-old male who suffered from a work-related injury that resulted in debilitating complex regional pain syndrome in his left arm and hand. Ultimately the patient had an upper cervical retrograde spinal cord stimulator placed in 2014 that significantly relieved his pain. Unfortunately, he experienced several wound infections that required multiple wound revisions with debridement. This past year, he returned to our institution for the removal of the stimulator, as it was not fulfilling its purpose of relieving his symptoms. Surgery was uneventful; however, post-operatively the patient developed profound left-sided hemiparesis that required an emergent CT scan followed by surgical exploration.
Results: A stat CT scan revealed an epidural mass concerning for epidural hematoma compressing the thecal sac at the location of the original spinal cord stimulator. An emergent C1-3 laminectomy revealed no epidural hematoma but a large, fibrous mass most consistent with a granuloma, which was confirmed on pathologic inspection.
Conclusions: Although rare, only 6 other case reports of granuloma formation associated with spinal cord stimulators have been reported. These previous reports have described gradual symptom onset associated with granuloma formation. To our knowledge, there have been no case reports of acute weakness due to an apparently asymptomatic granuloma that caused spinal cord compression immediately after removal of the stimulator. Our patient showed instantaneous signs of recovery after the surgery. Therefore, transient granuloma expansion and subsequent spinal cord compression should be taken in consideration after acute deterioration following removal of spinal cord stimulators.
Patient Care: By alerting colleagues of a very rare complication associated with SCS removal.
Learning Objectives: 1. Granuloma formation associated with SCS placement is an incredibly rare event, but has been reported.
2. Acute deterioration following removal of spinal cord stimulators prompts immediate attention with epidural hematoma and transient granuloma expansion at the top of the differential.
3. Here we present the only known case of acute weakness due to granuloma expansion and spinal cord compression after SCS removal.