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Case Reports
. 2016 Jan;158(1):147-54.
doi: 10.1007/s00701-015-2627-x. Epub 2015 Nov 17.

Twiddler's syndrome in spinal cord stimulation

Rafid Al-Mahfoudh  1   2 , Yuen Chan  3 , Hsu Pheen Chong  3 , Jibril Osman Farah  3
Affiliations
Case Reports

Twiddler's syndrome in spinal cord stimulation

Rafid Al-Mahfoudh et al. Acta Neurochir (Wien). 2016 Jan.

Abstract

Background: The aims are to present a case series of Twiddler's syndrome in spinal cord stimulators with analysis of the possible mechanism of this syndrome and discuss how this phenomenon can be prevented.

Method: Data were collected retrospectively between 2007 and 2013 for all patients presenting with failure of spinal cord stimulators. The diagnostic criterion for Twiddler's syndrome is radiological evidence of twisting of wires in the presence of failure of spinal cord stimulation.

Results: Our unit implants on average 110 spinal cord stimulators a year. Over the 5-year study period, all consecutive cases of spinal cord stimulation failure were studied. Three patients with Twiddler's syndrome were identified. Presentation ranged from 4 to 228 weeks after implantation. Imaging revealed repeated rotations and twisting of the wires of the spinal cord stimulators leading to hardware failure.

Conclusions: To the best of our knowledge this is the first reported series of Twiddler's syndrome with implantable pulse generators (IPGs) for spinal cord stimulation. Hardware failure is not uncommon in spinal cord stimulation. Awareness and identification of Twiddler's syndrome may help prevent its occurrence and further revisions. This may be achieved by implanting the IPG in the lumbar region subcutaneously above the belt line. Psychological intervention may have a preventative role for those who are deemed at high risk of Twiddler's syndrome from initial psychological screening.

Keywords: Failed back surgery syndrome; IPG; Spinal cord stimulation; Twidder’s syndrome.

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Figures

Fig. 1
Fig. 1
Lateral plain abdominal X-ray showing twisting of the connecting wires adjacent to the IPG
Fig. 2
Fig. 2
Lateral plain abdominal X-ray showing multiple twists of the connecting wires adjacent to the IPG
Fig. 3
Fig. 3
IPG with twisted wires after removal from patient
Fig. 4
Fig. 4
Schematic diagram illustrating IPG site for revision cases
See this image and copyright information in PMC

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