• Devang Padalia, Tigran Kesayan, Aaron J Martin, and Neal Shah.
• Interventional Pain Service, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, U.S.A.
• Pain Pract. 2020 Jun 1; 20 (5): 534-538.

BackgroundSpinal cord stimulation (SCS) is a relatively safe therapy for the treatment of pain but has the potential for several complications, including lead migration and breakage. While instances of lead breakage and electrode shearing have been described, there are no reported cases of stimulator lead transection and migration to the foramen magnum.AimsWe describe the case of a 53-year-old woman who reported that her cervical spinal cord stimulator was no longer functioning after a traumatic fall.CaseFluoroscopy of the neck revealed that one of the MRI conditional leads had migrated cephalad, and the distal aspect appeared to be transected. This was confirmed by computerized tomography, which showed a transected portion of the lead in the epidural space, just inferior to the posterior aspect of the foramen magnum. An SCS device revision was performed to replace the lead, but the distal transected tip was left in place in the epidural space adjacent to the foramen magnum to avoid complications of retrieval.Discussion/ConclusionGiven the location of the transected portion of the lead, we recommended avoiding MRI imaging. In addition, we advised the patient that a repeat x-ray may be necessary if she has increased neck pain or any other concerning symptoms. In this report, we discuss the known complications with SCS, as well as management of a retained lead fragment.© 2019 World Institute of Pain.

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