Lead fracture of peripheral nerve stimulator for brachial plexopathy -a case report-

This is the authors' abstract. We don't add key points for this paper.

Neuromodulation techniques such as spinal cord stimulation (SCS) and peripheral nerve stimulation (PNS) are safe and effective treatments for various chronic pain conditions [1][2][3].Complications related to SCS and PNS can be classified as hardware-related, programming-related, or biological, with the first being the most common [4].Hardware-related complications include electrical lead migration, fracture, and malfunction; extension lead disconnection or misconnection; and battery de-pletion, flipping, and recharging problems [4,5].Among them, lead fracture is rare, especially in PNS [4,6], and is associated with lead location and extension length [7].We performed PNS on the medial cord and radial nerve near the shoulder joint.The shoulder joint has the widest range of motion in the body, so the electrical lead is vulnerable to damage.We report an electrical lead injury associated with repetitive joint motion, which is an uncommon hardware-related complication in PNS. Case ReportIn 2015, a 54-year-old man underwent PNS for brachial plexopathy that resulted from a video-assisted thoracoscopic surgery (VATS) for a superior mediastinal schwannoma that was performed eight years earlier.After the VATS, he reported pain in his medial and posterior forearm, especially in areas innervated by the posterior and medial antebrachial cutaneous nerves.He rated his pain intensity as 8-9 on a 10-point numeric rating scale (NRS) in which 0 indicates no pain and 10 indicates the worst pain imaginable.Electromyography revealed left brachial plexopathy that mainly involved the medial and posterior cords.The Case ReportPeripheral nerve stimulation (PNS) is a useful treatment for chronic pain, but it can cause damage depending on its application site.Here, we describe the case of a 54-year-old man who underwent PNS for brachial plexopathy in 2015.One lead was implanted on the left medial cord to stimulate the medial antebrachial cutaneous nerve, and the other was implanted on the radial nerve to stimulate the posterior antebrachial cutaneous nerve.Both leads were inserted near the shoulder joint but did not cross it.Before PNS, the patient did not move his shoulder and elbow because of severe pain, but the treatment greatly alleviated this pain.Twenty months after the operation, both leads were fractured, and the severe pain returned.Repetitive motion near the joint was closely related to the lead fractures.In conclusion, large joints as the insertion sites of PNS leads should be avoided to prevent lead fractures.