# Twiddler’s Syndrome Involving a Deactivated, In Situ Spinal Cord Stimulator: A Case Report

## TL;DR

A man with a deactivated spinal cord stimulator experienced new pain due to hardware migration, resolved after device removal.

## Contribution

Highlights a rare complication of an inactive spinal cord stimulator causing pain through hardware migration.

## Key findings

- Rotational migration of an inactive implantable pulse generator caused flank pain.
- Symptoms resolved after complete removal of the spinal cord stimulator device.
- Multidisciplinary evaluation was crucial for diagnosis and management.

## Abstract

We present the case of a 63-year-old male presenting with unremitting acute flank pain ipsilateral to an implantable pulse generator (IPG) of an in situ spinal cord stimulator (SCS) that was permanently deactivated 12 years prior after a successful lumbar spine surgery for low back pain radiating into the bilateral lower extremities. Comparison of a current-day chest computed tomography (CT) scout film with a chest CT scout film obtained 12 years prior demonstrated rotational migration of the IPG in the patient’s flank and elongation of the extension cable. The inactive epidural lead did not show evidence of migration. Removal of the entire SCS device resulted in the resolution of the patient’s symptoms. This case stresses the importance of considering hardware-related complications when assessing new pain localized near an implant. A high level of clinical suspicion and a multidisciplinary approach were critical to the prompt management of this case.