Twiddler's syndrome: A rare hardware complication in spinal cord stimulation

Twiddler's syndrome is an uncommon hardware complication involving the lead and pulse generators in cardiac pacemakers and defibrillators, deep brain stimulators, and vagal nerve stimulators. However, until very recently, it had not been reported in spinal cord stimulation (SCS). Considering the incidence of hardware complications of spinal cord stimulation, there may be an underreporting of Twiddler's syndrome due to lack of awareness. Two cases of Twiddler's syndrome as a hardware complication of SCS were identified between 2005 and 2015. One patient with hardware failure due to Twiddler's syndrome refused to have a revision surgery. The other patient who had a lead migration associated with coiling of the lead and twisting of pulse generator needed a revision surgery. Twiddler's syndrome in patients treated with SCS is an uncommon but important adverse event. Awareness of characteristic presentation and radiologic finding is essential in the identification of Twiddler's syndrome in SCS.