Ten years after placement of a spinal cord stimulator (SCS) and resolution of pain, this patient presented with progressive paraplegia, worsening thoracic radicular pain at the same dermatome level of the electrodes, and bowel and bladder incontinence. Computed tomographic myelogram confirmed thoracic spinal cord central canal stenosis at the level of electrodes. After removal of the fibrotic tissue and electrodes, the patient had resolution of his thoracic radicular pain and a return of his pre-SCS pain and minimal neurologic and functional return. To the authors' knowledge, no studies have been identified with thoracic SCS lead fibrosis in the United States causing permanent paraplegia. Only one other case has been reported in Madrid, Spain. Patients with SCS presenting with loss of pain relief, new-onset radicular or neuropathic pain in same dermatome(s) as SCS electrodes, worsening neuromuscular examination, or new bladder or bowel incontinence need to be evaluated for complications regarding SCS implantation causing spinal stenosis and subsequent cord compression to avoid permanent neurologic deficits.

No abstract

Direct tests by the microneuronographic recording of muscle afferent fibres of spastic human subjects show that the gamma system is not overactive, and the muscle spindles do not have an increased sensitivity to stretch in spasticity. A substantial body of work has compared the human H reflex with the tendon (T) reflex in an attempt to separate the contributions of the monosynaptic reflex as against those of the gamma system. Both electrical stimulation of the tibial nerve and a tap of the tendo Achilles would produce a monosynaptic reflex contraction of the soleus. The electrical stimulus, however, would bypass the muscle spindle, and produce an H reflex of amplitude dependent only upon the excitability of the monosynaptic reflex. Comparison of the H and T reflexes indicates the activity in the gamma system. A tendon tap produces a wave of vibration spreading through the muscle, and muscles' spindles are excited asynchronously, producing an input volley to the spinal cord lasting as long as 20–30 msec.