Twiddler’s Syndrome Involving a Deactivated, In Situ Spinal Cord Stimulator: A Case Report

We present the case of a 63-year-old male presenting with unremitting acute flank pain ipsilateral to an implantable pulse generator (IPG) of an <i>in situ</i> spinal cord stimulator (SCS) that was permanently deactivated 12 years prior after a successful lumbar spine surgery for low back pain radiating into the bilateral lower extremities. Comparison of a current-day chest computed tomography (CT) scout film with a chest CT scout film obtained 12 years prior demonstrated rotational migration of the IPG in the patient's flank and elongation of the extension cable. The inactive epidural lead did not show evidence of migration. Removal of the entire SCS device resulted in the resolution of the patient's symptoms. This case stresses the importance of considering hardware-related complications when assessing new pain localized near an implant. A high level of clinical suspicion and a multidisciplinary approach were critical to the prompt management of this case.