[Pulmonary branch embolism after short-term spinal cord stimulation for zoster-associated pain: Two cases and a literature review].

Short-term spinal cord stimulation (st-SCS), as a minimally invasive neuromodulation technique for zoster-associated pain (ZAP), can effectively relieve pain and reduce the incidence of postherpetic neuralgia (PHN). This paper reports two elderly male patients with ZAP admitted to the First Affiliated Hospital, Zhejiang University School of Medicine in August 2024, who developed acute pulmonary embolism (APE) 3 days after st-SCS implantation. Both patients had preoperative high-risk factors, including a history of hypertension and elevated D-dimer levels. Close monitoring of D-dimer levels was performed after st-SCS. When further elevation was observed, computed tomography angiography (CTA) was conducted promptly. After APE was confirmed, anticoagulation therapy with low-molecular-weight heparin bridging to direct oral anticoagulants (DOACs) was initiated, followed by electrode removal. At 3-month follow-up after discharge, repeat pulmonary CTA showed no significant embolism. Advanced age, preexisting cardiovascular and cerebrovascular diseases, elevated preoperative D-dimer levels, perioperative stress, and postoperative immobility due to fear of electrode displacement were all high-risk factors for thrombosis. During the perioperative period, a comprehensive prevention strategy should be established, including preoperative Caprini risk assessment, D-dimer evaluation, and lower-extremity vascular ultrasound screening, intraoperative physical prophylaxis, early postoperative mobilization, and dynamic monitoring of D-dimer levels. Multidisciplinary collaboration should be adopted to optimize individualized management. Based on the above experience, no cases of APE occurred among the subsequent 68 patients with ZAP treated with st-SCS in our hospital, suggesting that APE is preventable and controllable.