Sudden onset Brown-Sequard-like symptoms due to fibrotic scar tissue formation around spinal cord stimulator...

Spinal cord stimulation (SCS) is a widely used therapy for chronic neuropathic pain. Although generally safe, rare complications such as spinal cord injury can occur. Most cases present within days to weeks of implantation.

A 48-year-old female with chronic back pain was treated with SCS placement at T9-T10 in 2008. Seventeen years later, she presented with the sudden onset of paraparesis (greater on left), a T10 sensory loss to pin appreciation, and bowel incontinence. Her examination was consistent with a Brown-Sequard like syndrome. Once the SCS was removed, the magnetic resonance imaging (MRI) showed significant residual cord compression due to an epidural mass extending from T8 to T10; causing hyperintense T2 signal changes in the cord. Following a T8-T10 laminectomy with resection of the fibrotic tissue, the patient improved regarding her gait but still had residual numbness in both lower extremities. The postoperative MRI 4 weeks later revealed no residual stenosis or spinal cord compression, but faint T2 signal changes within the cord remained.

This case highlights how a SCS resulted in the late onset (i.e. 17 years later) of a Brown-Séquard like syndrome attributed to placement of a SCS.