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Abducens Nerve Palsy - A Rare Complication of Spinal Cord Stimulator Insertion: Case Report and Literature Review
Vanessa Jane Chow1, Avinash Kumar Hari Narayanan1, Kavita Poply2
1Department of Neurosurgery, Royal London Hospital, Barts Health NHS Foundation Trust, London, UK.
Background:
Spinal cord stimulation (SCS) is an emerging therapeutic intervention for intractable chronic pain. However, SCS surgery is not exempt from complications such as lead migration, infections, hardware malfunction and neurological deficits.
Case Report:
We present this case report on bilateral abducens nerve palsy, as a rare iatrogenic complication of SCS system insertion in a 65-year-old man with intractable chronic pain. After failing conservative treatment and explant, he underwent corrective strabismus surgery and achieved symptom control.
Conclusion:
The case presents a diagnostic and management challenge due to the nature of his presentation, neuroimaging pitfalls and limited high-quality evidence for management. We recognise cranial nerve palsy as a potential, yet real, complication of SCS surgery, of which abducens nerve palsy presents significant detriment to patients lives. As SCS continues to expand in clinical practice, inevitably, so will its iatrogenic sequela signalling the need for greater recognition and formation high-quality evidence for efficacious management.
