Immediate Abdominal Pain after Placement of Thoracic Paddle Leads for Spinal Cord Stimulation: A Case Series

Abstract

Background: Spinal cord stimulation (SCS) is a well-established treatment modality for chronic pain. Thoracic radiculopathy has been reported as a complication of SCS paddle lead implantation by several authors and commonly presents as abdominal pain. Methods: We performed a search of all patients who underwent either placement of a new epidural paddle lead electrode or revision of an epidural paddle lead electrode for SCS in the thoracic region from January 2017 to January 2018. We then investigated all cases of immediate postoperative abdominal pain. Results: We identified 7 patients who had immediate postoperative abdominal pain among 86 cases of epidural SCS procedures. Most patients were discharged on postoperative days 1–3. No patients required revisions or removals of their SCS for any reason. Conclusions: We conclude that the etiology of immediate postoperative abdominal pain after thoracic paddle lead implantation for SCS is most likely thoracic radiculopathy. We hypothesize that small, transient epidural hematomas could be the cause of this thoracic radiculopathy. We argue that all patients with immediate postoperative abdominal pain and no other neurologic deficits after thoracic paddle lead implantation for SCS should first be treated conservatively with observation and pain management.

Ogilvie's syndrome after paddle spinal cord stimulator implantation: An experience report

“…Two case series reported an incidence of 8%–9% for nerve root irritation after mid‐thoracic laminectomy and paddle SCS implant 7,8 . The immediate postoperative spinal exam of the patient did not reveal deficits and the patient did not complain of pain.…”

“…Two case series reported an incidence of 8%-9% for nerve root irritation after mid-thoracic laminectomy and paddle SCS implant. 7,8 The immediate postoperative spinal exam of the patient did not reveal deficits and the patient did not complain of pain. About 30 min later when the SCS was turned on, he reported sudden unbearable bilateral cramping and abdominal pain.…”

“…7 In a more recently published series of 86 cases, seven patients (8%) reported postoperative abdominal pain, of which none required revisions or removals and all were discharged after 1-3 days of observation and treatment with pain medication and steroids. 8 Ogilvie's syndrome (OS) is a rare disorder of unknown pathophysiology characterized by acute dilatation of the colon in the absence of an anatomic lesion that obstructs the flow of intestinal contents. 9,10 OS has also been observed after spine surgery, especially in the lumbar region.…”

“…In a retrospective analysis of prospectively acquired data over a 10‐year period with a total of 176 patients with thoracic SCS paddle implants, 15 patients (9%) reported thoracic radicular symptoms with abdominal cramping 7 . In a more recently published series of 86 cases, seven patients (8%) reported postoperative abdominal pain, of which none required revisions or removals and all were discharged after 1–3 days of observation and treatment with pain medication and steroids 8 . Ogilvie's syndrome (OS) is a rare disorder of unknown pathophysiology characterized by acute dilatation of the colon in the absence of an anatomic lesion that obstructs the flow of intestinal contents 9,10 .…”

Development of a Modified Bayonet Forceps for Improving Steerability of Paddle Lead Electrodes During Spinal Cord Stimulator Surgery: A Technical Note

“…11 In addition, inaccurate placement may result in suboptimal pain control 33 or the well-described but still poorly understood phenomenon of new-onset thoracic radiculopathy after SCS implantation. 7,35…”