Practice Parameters for the Use of Spinal Cord Stimulation in the Treatment of Chronic Neuropathic Pain

Epidural Hematoma

What is the incidence, time to appearance of symptoms, usual resolution and impact on therapy, and worst case adverse sequelae of epidural hematoma or abscess following SCS treatment, and how can this risk be reduced?

  • Incidence: rare
  • Time to appearance of symptoms: variable (minutes to days)
  • Treatment: urgent or emergent surgical evacuation
  • Usual resolution and impact on therapy: If treated in time, the problems caused by a hematoma might resolve; electrode removal obviously interrupts SCS therapy.
  • Worst case adverse sequelae: paralysis
  • Risk reduction: Review the patient's coagulation history, medications, and preoperative blood studies.  Monitor the patient closely for a reasonable period of time.  Some clinicians observe patients overnight, believing the risk reduction offered by this measure outweighs the expense.
Strength of recommendation Evidence source(s)/rationale
B = Recommended
Uncertain validity, apparently useful
  • Consensus
  • Cohort studies
  • Retrospective case series
  • Case reports 

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Abstract | Wikistim Entry

Smith CC. Lin JL, Shokat M, Dosanjh SS, Casthely D A report of paraparesis following spinal cord stimulator trial, implantation and revision. Pain Phys 13:357-363 2010.
Abstract | Wikistim Entry

Shealy CN. Dorsal column stimulation: optimization of application. Surg Neurol 4(1):142-145, 1975.
Abstract | Wikistim Entry

Meglio M, Cioni B, Rossi GF. Spinal cord stimulation in management of chronic pain. A 9-year experience. J Neurosurg 70(4):519-524, 1989.
Abstract | Wikistim Entry

Levy R, Henderson J, Slavin K, Simpson BA, Barolat G, Shipley J, North R Incidence and avoidance of neurologic complications with paddle type spinal cord stimulation leads. Neuromodulation 14:412-422, 2011.
Abstract | Wikistim Entry

Franzini A, Ferroli P, Marras C, Broggi G. Huge epidural hematoma after surgery for spinal cord stimulation. Acta Neurochir (Wien) 147(5):565-567, 2005.
Abstract | Wikistim Entry

Bennett DS, Aló KM, Oakley J, Feler CA. Spinal cord stimulation for complex regional pain syndrome I (RSD). A retrospective multicenter experience from 1995-1998 of 101 patients. Neuromodulation 2(3):202-210, 1999.
Abstract | Wikistim Entry

Barolat G Spinal cord stimulation for chronic pain management. Arch Med Res 31:258-262, 2000.

Aló KM, Redko V, Charnov J. Multiple program spinal cord stimulation in the treatment of chronic pain: follow-up of multiple program SCS. Neuromodulation 2(4):266-272, 1999.
Abstract | Wikistim Entry

Aló KM, Redko V, Charnov J. Four year follow-up of dual electrode spinal cord stimulation for chronic pain. Neuromodulation 5(2):79-99, 2002.
Abstract | Wikistim Entry

Abejón D, Reig E, del Pozo C, Contreras R, Insausti J. Dual spinal cord stimulation for complex pain: preliminary study. Neuromodulation 8(2):105-111, 2005.
Abstract | Wikistim Entry