Twiddler's syndrome in spinal cord stimulation

Area of Science:

• Neuromodulation
• Medical Device Engineering
• Surgical Complications

Background:

• Spinal cord stimulators (SCS) are used for chronic pain management.
• Hardware complications can impact SCS efficacy and patient outcomes.
• Twiddler's syndrome is a rare but significant cause of SCS failure.

Observation:

• A case series identified three patients with Twiddler's syndrome over a 5-year period.
• Radiological evidence showed wire twisting of the SCS implantable pulse generator (IPG).
• Failures occurred between 4 and 228 weeks post-implantation.

Findings:

• Twiddler's syndrome involves repeated rotation of SCS IPG wires, leading to hardware malfunction.
• This series is the first to report on Twiddler's syndrome specifically in SCS IPGs.
• Hardware failure is a recognized issue in SCS therapy.

Implications:

• Increased awareness of Twiddler's syndrome can aid in prevention and reduce revision surgeries.
• Subcutaneous IPG implantation in the lumbar region, above the belt line, may mitigate risk.
• Pre-operative psychological screening could identify patients at higher risk for developing Twiddler's syndrome.