Cervical spinal cord stimulator trial complicated by epidural abscess

Spinal cord stimulation (SCS) is a growing interventional treatment modality in patients experiencing intractable pain refractory to conservative treatments. Many patients with chronic low back and leg pain that persists after surgery have found pain relief, and more evidence is suggesting that chronic upper limb and neck pain may respond just as well to this therapy. However, the placement of foreign body, for instance SCS leads, in the epidural space can become the source for deep intra-spinal infection.

We present a 49-year-old robust male who underwent a temporary cervical SCS trial and was diagnosed with epidural abscess on the day 9 when the leads were pulled. The trial phase was complicated by immediate and prolonged post procedure pain. The diagnosis of epidural abscess was made soon after clinical presentation with no neurological deficits or escalation in pain but new onset fever. He made a complete recovery after extensive laminectomy and antibiotic treatment.

The decision to extend the SCS trial length poses a question of risk versus benefit in regards to potential infectious complications versus pain relief. Continuing antibiotic therapy during a SCS trial phase is a possible strategy but of uncertain benefit.

Anesthesiology, Pain Management.