Designed & produced by The Department of Medical Illustration & Graphic Design, ew Cross Hospital, wolverhampton, WV10 0QP. Tel: 01902 695377.
Autologous Fat Transfer To Prevent Spinal Cord Stimulation (Scs) Lead Extrusion - A Case Report L. Radhakrishnan1, H. Mutagi2, M. Ali3, D. Miminas3, S. Kapur2, J. Raphael4,5 Anaesthesia, Leicester Royal Infirmary, Leicester, Anaesthesia and Pain Management, Plastic Surgery, 4 Pain Management, Dudley Group of Hospital NHS Trust, Dudley, 5City of Birmingham University, Birmingham, UK 2
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Background and aims: Extrusion and associated infection of implanted spinal cord stimulation (SCS) system is a recognized complication. We present a case of near-extrusion of SCS lead successfully managed by autologous fat transfer.
Methods: A 39 year old slender-build female suffering with complex regional pain syndrome type-1 (CRPS-1) of the right foot refractory to conservative multidisciplinary management responded well to SCS (mid-lumbar paramedian access, single octrode at T10 dorsal epidural space). Lead migration, eight weeks later, prompted revision surgery to place dual octrode T12-L1 dorsal epidural leads and reinstate therapy. Reassessment for refractory low back pain identified nearextruding strain-relief loop of subcutaneously implanted SCS. The lead loop was buried deeper with transient benefit.
fig 1 - near extruding loop of SCS lead (marked)
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Recurrent near-extrusion of the lead after 12 weeks necessitated Plastic Surgery input and autologous fat transfer was decided. Fat was harvested from the buttock and thigh areas through liposuction, centrifuged for five minutes, and supra- and infra-natant fluid was discarded. 30 ml of fat was injected over the near-extruding lead to achieve adequate padding. Back pain and sensitive overlying the SCS strain-relief loop of SCS lead resolved as assessed at tenth week follow-up.
Discussion and conclusion: SCS lead strain-relief loop accommodate posture related elongation of lead track. The natural uncoiling tendency of stiff leads can erode through overlying tissue especially in slender, elderly and steroid-induced dermal atrophy. Prevention of extrusion ensures continued therapy and avoids infection with potential need for explantation of SCS, interruption of therapy and significant healthcare cost to reinstate it. Autologous fat transfer appears to provide adequate padding for the strain-relief loop of SCS.
fig2 - Immediate post operative
fig 3- well padded loop of SCS lead at 10 weeks follow-up Designed & produced by The Department of Medical Illustration & Graphic Design, ew Cross Hospital, wolverhampton, WV10 0QP. Tel: 01902 695377 Mi 367809
