• Bruno Antonio Zanfini, Salvatore De Martino, Luciano Frassanito, Stefano Catarci, Francesco Vitale di Maio, Pietro Paolo Giuri, Gian Luigi Gonnella, and Gaetano Draisci.
• Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Largo A. Gemelli 8, 00168, Rome, Italy. brunoantonio.zanfini@policlinicogemelli.it.
• BMC Anesthesiol. 2020 May 23; 20 (1): 122.

BackgroundThe use of Spinal Cord Stimulation (SCS) system to treat medically refractory neuropathic pain is increasing. Severe neuropathic pain can be found in giant chest wall arteriovenous malformations (AVMs), exceedingly rare and debilitating abnormalities, rarely reported during pregnancy.Case PresentationWe present a report of a pregnant patient with implanted Spinal Cord Stimulation (SCS) system because of painful thoracic AVM scheduled for an urgent cesarean section in which we used lumbar ultrasound (US) to rule out the possibility to damage SCS electrodes and to find a safe site to perform spinal anesthesia.ConclusionsThe use of lumbar US to find a safe site for a lumbar puncture in presence of SCS system in a patient affected by painful thoracic AVM makes this case a particularly unique operative challenge and offers a new possible use of ultrasound to detect a safe space in patients with SCS implant.

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