833 - Reviving an 18-year-old spinal cord stimulator

Case Diagnosis: Complex Regional Pain Syndrome Type 1

Case Description: A 66-year-old patient with a history of incomplete SCI and bilateral lower extremity CRPS type 1 presents with progressive intractable pain requiring 120 morphine milligrams milliequivalents per day. The patient previously had a conventional spinal cord stimulator (SCS) implanted 18 years ago, but he reports failure of the device to provide relief for the past 3 years. X-rays revealed optimal SCS lead position. No impedances were detected upon interrogation. The device impulse generator (IPG) was replaced and connected to the original leads. Retrial interrogation revealed appropriate function without lead impedances. On POD 5, the patient had 90% improvement in pain and titrated off 50% of his opioids. The patient reported an increased ability to participate in therapies with significant improvement in functional ability and activities of daily living.

Discussions: SCS is an effective pain management method for patients with CRPS 1. Complication rates after SCS implantation can occur in up to 40% of cases and may be more common in CRPS patients. Device failures are typically hardware-related including IPG migration, lead migration or fracture, or IPG malfunction. IPG malfunction is mostly likely to occur within 4 to 7 years, and within 5 years nearly 80% of patients experience lead migration. This patient had 15 years of pain relief with his original SCS. The patient's workup ruled out IPG migration and fracture of the leads. After simple IPG replacement into the original leads placed 18 years prior clinically significant pain relief was restored.

Conclusions: SCS can be a long-term pain relief solution of CPRS. We describe a patient case where their SCS functioned for 15 years and required simple replacement of the IPG with the originally placed leads to restore device function and provide significant pain relief 18 years after implantation.