Wet Tap-Induced Spinal Cord Stimulator Trial Failure in Failed Back Surgery Syndrome: A Case Report Highlighting Intrathecal Drug Delivery for Treatment-Resistant Pain

Abstract

A 59-year-old female with failed back surgery syndrome (FBSS) following multiple lumbar surgeries underwent a spinal cord stimulator (SCS) trial for chronic pain management. However, the trial failed due to severe nausea, vomiting, and postural headaches secondary to unintentional dural puncture (wet tap) during lead placement. This resulted in cerebrospinal fluid (CSF) leakage, low-pressure headaches, and subsequent trial intolerance, necessitating early lead removal. Given her failed response to conservative treatments, neuropathic medications, and systemic opioids, an intrathecal pump (ITP) trial was pursued, yielding 90% pain relief and leading to permanent pump implantation. This case highlights the impact of procedural complications on neuromodulation outcomes and the role of intrathecal drug delivery as an alternative in patients who cannot tolerate SCS.

Keywords: failed back surgery syndrome (fbss); intrathecal pump therapy; neuromodulation therapies; spinal cord stimulation (scs); unintentional dural puncture.

Figure 1. Lateral lumbar X-ray view demonstrating intrathecal catheter tip placement. The black arrow on the left highlights the path of the catheter extending toward the spinal canal.