Spinal epidural hematoma and permanent paraplegia following spinal cord stimulator implantation: a case report

Spinal cord stimulators (SCS) have gained widespread popularity as an intriguing tool for managing chronic neurogenic pain. Despite the growing adoption of SCS as a therapeutic approach, there is a lack of demonstrated efficacy. The clinical utilization of SCS is on the rise, despite potential severe complications and the absence of clear evidence supporting its therapeutic benefits.

We present a challenging case of acute spinal epidural hematoma secondary to SCS placement in a liver transplant recipient. The patient exhibited acute bilateral leg weakness, sensory deficits, and urinary dysfunction, 2 days after SCS placement. Urgent surgical decompression was performed 3 days after the permanent placement of the SCS. Even with multiple debridement procedures the patient did not regain any function and remained paraplegic. This case underscores the importance of vigilant monitoring post operatively and timely intervention when epidural hematomas develop. The patient's intricate medical background, encompassing liver transplantation and chronic immunosuppression, contributed to the complexity of the case. Given these evident co-morbidities, the justification for SCS should have been unequivocal. However, what we observe is a vague clinical indication with minimal consideration for the associated risks.

This case highlights the need for cautious consideration of SCS due to its serious and lasting side effects in treating chronic back pain. Surgeons should reevaluate the widespread use of SCS, advocating for reserved usage in controlled trials until therapeutic benefits are firmly established. Despite potential pain relief, the risk of complications, including spinal epidural hematoma, should not be underestimated. Further research is urged to understand therapeutic benefits and assess short- and long-term complications comprehensively.