A novel case of refractory hiccups following epidural thoracic spinal cord stimulator implantation for chronic low back pain

Abstract

Background: Spinal cord stimulation for the treatment of chronic refractory back pain is widely used and is associated with low risk. The onset of chronic debilitating hiccups following SCS implantation has not been previously reported. We describe a novel case of intractable hiccups following the placement of a thoracic epidural paddle electrode for the treatment of chronic back pain, and discuss the underlying pathophysiology of hiccups in association with SCS insertion. Case Description:: We describe a case of a 61-year-old male who presented with refractory chronic low back, coccygeal, and radicular lower extremity pain. A SCS trial provided 60 % improvement in pain, and therefore he underwent implantation of a 2x8 electrode epidural paddle lead spanning the T9 vertebral body. Post-operatively, the patient’s pain was improved, however he experienced new-onset involuntary abdominal spasms and hiccups. He underwent a comprehensive medical work-up, several SCS reprogramming trials, and revision surgeries. Abdominal spasms resolved; however, the hiccups insidiously worsened. At 3.5 years post-implantation, he reports ongoing adequate pain control but continues to experience debilitating, severe hiccups. Conclusions: This case illustrates a unique and unexpected outcome of new-onset intractable hiccups following placement of an epidural thoracic SCS lead. Whether this complication of SCS lead placement is consequent to aberrant stimulation of the hiccup reflex arc or injury to the thoracic spinal cord is not yet clear and may be elucidated by future research.

Keywords

• Spinal cord stimulation
• Chronic low back pain
• Intractable hiccups