Abstract:
The authors describe a case of delayed spastic quadriparesis caused by a peri-electrode mass following the implantation of a minimally invasive percutaneous spinal cord stimulator (SCS). Prior reports with paddle-type electrodes are reviewed, and a detailed histological and pathophysiological comparison with the present case is made. The patient developed tolerance to a cervical percutaneous SCS 4 months after implantation, followed by the onset of spastic quadriparesis 9 months after implantation. The stimulator was removed, and contrast-enhanced MRI revealed an enhancing epidural mass where the system had been placed, with severe spinal cord compression. Decompression was carried out, and the patient experienced neurological improvement. Pathological examination revealed fibrotic tissue with granulomatous and multinucleated giant cell reactions. No evidence of infection or hemorrhage was found. Professionals treating patients with SCSs or contemplating their insertion should be aware of this delayed complication and associated risk factors.
摘要:
作者描述了在植入微创经皮脊髓刺激器(SCS)后,由电极周围肿块引起的延迟性痉挛性四肢瘫痪的情况。回顾了桨式电极的先前报告,并与本案进行了详细的组织学和病理生理比较。植入后4个月,患者对宫颈经皮SCS产生了耐受性,植入后9个月出现痉挛性四肢瘫痪。刺激器被移除,对比增强MRI显示,在系统放置的地方,硬膜外肿块增强,严重的脊髓压迫。进行了减压,患者的神经系统得到了改善.病理检查显示纤维化组织伴有肉芽肿和多核巨细胞反应。没有发现感染或出血的证据。治疗SCSs患者或考虑插入SCSs的专业人员应意识到这种延迟的并发症和相关的危险因素。