1. 2014;17;E397-E403Case Series on Variable Presentation of Ligamentum Flavum Stimulation Following Percutaneous Cylindrical Spinal Cord Stimulator Lead Implants
   Case Series
   Susie S. Jang, MD, Jeffrey E. Arle, MD, PhD, Jatinder S Gill, MD, and Thomas T. Simopoulos, MD.

BACKGROUND: Stimulation-evoked discomfort secondary to ligamentum flavum stimulation (LFS) is a technological limitation of percutaneous spinal cord stimulator (SCS) lead implants. There is a paucity of literature describing the clinical presentation and time periods at which this side effect may present following insertion of cylindrical lead(s).

OBJECTIVE: To describe a series of 5 patients who presented at varying time periods after SCS lead placement with LFS.

STUDY DESIGN: Retrospective case series.

METHODS: We performed a chart review of online medical records of patients with symptoms consistent with LFS at an academic interventional pain clinic identified over 7 consecutive years (2006 - 2013).

RESULTS: LFS most frequently presented within months of implantation of cylindrical leads. One patient complained of LFS during the temporary trial while another developed LFS after lead revision. All patients were successfully treated when paddle electrodes replaced percutaneous cylindrical leads.

CONCLUSION: LFS may present as a barrier to successful SCS treatment. Clinicians placing percutaneous SCS leads should be aware of the variable time course of LFS presentation. Paddle style electrodes seem to offer an enduring solution to LFS so that patients may continue to benefit from SCS therapy.