Spinal cord stimulation in the first two trimesters of pregnancy: case report and review of the literature.

Introduction. Spinal cord stimulation (SCS) is an accepted cost-effective therapy for many chronic pain syndromes. Its effects on pregnancy have not been studied because of stringent regulation and manufacturers' recommendations. However, childbearing women who had SCS become or choose to become pregnant despite these policies. It is paramount to monitor, document, and report these effects of SCS during pregnancy to build clinical experience and guide recommendations and management. Methods. We reviewed the literature for SCS in pregnancy and added new case report of a young woman who had SCS implanted for chronic pain, became pregnant and at the end of the second trimester the lead extender had to be divided to relief pain at the lead site. Results. We found only one previous case report in this field and we add another case. Discussion. Our case is different from the previously reported case in that the implantable pulse generator (IPG) of our case was implanted in the anterior abdominal wall, while the previously reported case was implanted in the subclavicular fossa. Therefore our case highlights the need to implant the IPG in a way that avoids stretching the lead extender by the expanding abdomen. Conclusion. SCS seems to be safe in the first two trimesters of pregnancy based on these two case reports and the abdominal wall should be avoided as a site for IPG implantation in these patients. However, more cases are required to establish the safety of SCS in pregnancy.