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Scarring around cervical epidural stimulating electrode.
Neurosurgery
|July 1, 1983
Summary
Spinal cord stimulation electrode placement can cause scarring, leading to neurological issues. Prompt surgical removal of scar tissue reversed a patient's quadriparesis, highlighting the importance of addressing this complication.
Area of Science:
- Neurosurgery
- Neurology
- Biomaterials
Background:
- Concerns regarding scar tissue formation around implanted electrodes for spinal cord stimulation (SCS) have persisted since its inception.
- Epidural stimulation techniques for pain and spasticity management face similar challenges with potential dural scarring.
Observation:
- A patient receiving a C-2-C-4 electrode for torticollis developed spastic quadriparesis and diminished stimulation efficacy three months post-implantation.
- Reexploration revealed dense scar tissue encasing the electrode and constricting the cervical spinal cord.
Findings:
- Microdissection successfully removed the scar tissue, restoring free pulsation of the dura mater.
- The patient's quadriparesis resolved following the scar removal.
- Microscopic analysis of the scar tissue showed linearly arranged fibroblastic nuclei, with the cause of the excessive response remaining unclear (electrical stimulation, electrode materials, or surgical technique).
Implications:
- This case underscores the potential for significant neurological compromise due to scar formation around spinal cord stimulation electrodes.
- Prompt surgical intervention and scar revision can reverse debilitating neurological deficits.
- Further research is needed to elucidate the etiology of the fibroblastic response to optimize SCS device safety and efficacy.