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Permanent Peripheral Nerve Stimulator Lead Adhesions Leading to Loss of Therapy and Difficult Extraction: A Case
1University of Southern California, Department of Anesthesiology, Los Angeles, CA.
Background:
Over the past few decades, peripheral nerve stimulators (PNS) have become a useful option for treating refractory complex regional pain syndrome or neuralgia. Modern PNS are designed to prevent lead migration with tines or burs promoting tissue adhesion through fibrosis. However, few studies have examined the effect that this might have on nerve stimulation treatment. To our knowledge, this is the first documented case report describing how excessive scarring and fibrosis of leads may interfere with PNS therapy.
Case Report:
This paper describes a 67-year-old male patient who presented with peripheral neuropathy and peripheral vascular disease which was complicated by multiple surgical interventions and ischemia to his right lower extremity. He underwent permanent PNS treatment, but experienced treatment failure in both PNS leads - early on from lead migration, and later from significant adhesions leading to a difficult extraction.
Conclusion:
While tines and burs found on permanent PNS may prevent lead migration, the excessive scarring and fibrosis that they cause may interfere with PNS therapy by increasing impedance. More research is needed to better guide physicians in counseling and managing patients with refractory pain.
