Compressive cervicothoracolumbar epidural haematoma following lead insertion for spinal cord stimulator trial

Spinal cord stimulators (SCS) are used as treatment for back pain and associated radicular symptoms recalcitrant to both conservative measures and spinal surgery. This report reviews a case of a male in his 40s with a medical history pertinent for pulmonary hypertension presenting with lower extremity weakness and sensory deficits, inability to void and lower extremity pain after SCS trial procedure. MRI revealed a spinal epidural haematoma from C6 to L2 and cord compression from T10 to T11 inferiorly to L2. Coagulation studies were within normal limits. This profound bleeding is suspected to have occurred from disrupted epidural blood vessels, which may have been congested secondary to the patient's history of pulmonary hypertension. The patient was treated with emergent spinal decompression and haematoma evacuation with a resolution of presenting symptoms. This case underscores the importance of pre-implantation MRI to better characterise the anatomy of patients considering SCS to help limit adverse effects during implantation.