1. 2010;13;523-526Trial Spinal Cord Stimulator Reimplantation Following Lead Breakage after Third Birth
   Case Report
   Takayuki Noguchi, MD, PhD, Satoshi Hagiwra, MD, PhD, Junji Takatanin, MD, Kentaro Okuda, MD, and Naozumi Takeshima, MD, PhD.

BACKGROUND: Many studies have reported lead migration and breakage as complications of epidural spinal cord stimulation. In cases where rapid changes in physique such as those caused by pregnancy are expected, it is unclear whether extra consideration regarding possible adjustments and care to avoid complications such as lead breakage are required. OBJECTIVE: This article presents a case in which spinal cord stimulation was used to manage these complications in a woman during the perinatal period. DESIGN: Case report. SETTING: Pain management clinic. METHODS: The patient was a 36-year-old female, approximate weight of 100 pounds, and 5-foot 1 inch in height, whose chief complaint was lower back and bilateral leg pain. The pain could not be alleviated by conservative therapies such as nerve blockade, oral medications with non-steroidal anti-inflammatory drugs, antidepressants, anticonvulsants or physical therapy. A spinal cord stimulator was implanted at another facility, which relieved the pain. The patient subsequently had 2 vaginal births without any problems relating to the stimulation sites, and both infants were healthy. She experienced lead breakage after the third vaginal birth that led to the subsequent reimplantation procedure. RESULTS: The patient had 2 subsequent vaginal births following the initial implantation with no problems related to the stimulation sites, and both infants were healthy. At age 34, following her third vaginal birth, the stimulator became ineffective and was removed. The withdrawn lead wire was found to be broken in 2 places. LIMITATIONS: A case report. CONCLUSION: Pregnancy following implantation of a spinal cord stimulator might result in lead breakage as abdominal girth increases. The present case exemplifies how pregnancy following implantation of a spinal cord stimulator might cause lead breakage as abdominal girth increases. Extra care is required to prevent lead breakage when anchors are fixed.