Thoracic myelopathy secondary to epidural scarring with associated infection following spinal cord stimulation implantation.

BACKGROUND

Spinal cord stimulation (SCS) is a well-established therapy for chronic pain refractory to conventional medical management. While lead migration, hardware failure, and infection are the most frequently reported complications, delayed epidural fibrosis resulting in spinal cord compression is rare.

CASE DESCRIPTION: A 38-year-old male underwent a thoracic paddle-lead SCS implantation at T10-T11 and subsequently developed progressive gait disturbance followed by paraparesis. Thoracic computed tomography demonstrated marked dorsal epidural fibrosis surrounding the electrode, causing severe spinal cord compression. Explanation of the SCS system resulted in transient neurological improvement. However, this was followed by renewed progression of pyramidal signs. The thoracic magnetic resonance revealed a 4-cm T2-hyperintense, partially calcified epidural mass at T9-T10, with suspected intradural extension and associated myelomalacia. Under neuromonitoring-assisted thoracic laminectomy with microsurgical decompression, the T9/10 lesion was partially removed. Histopathological and microbiological analyses demonstrated chronic inflammatory fibro-adipose tissue, with growth of Cutibacterium acnes and Staphylococcus epidermidis; the latter required prolonged antibiotic therapy. Postoperatively, although the patient neurologically improved, he exhibited residual spastic paraparesis and urinary incontinence. The subsequent follow-up magnetic resonance imaging 1 year after surgery confirmed adequate decompression and stable myelomalacia.

CONCLUSION

Delayed epidural fibrosis attributed to chronic infection is a rare cause of delayed postoperative recurrent myelopathy secondary to fibrosis encountered following prior SCS implantation.