However, considering the reported incidence of about 0.39% by Al-Mahfoudh et al., there is a possibility that it has not been recognized and has been underreported. The reason why Twiddler's syndrome in SCS has not been reported is unclear. Twiddler's syndrome in spinal cord stimulation (SCS) was first reported by Al-Mahfoudh et al. Since then, Twiddler's syndrome has been mostly described with implanted cardiac devices, such as pacemakers and defibrillators, and has also been reported with deep brain and vagal nerve stimulators. who reported a single case of a cardiac pacemaker flipping on its long axis resulting in retraction of the leads and coiling around the pacemaker boot. It was first described in 1968 by Bayliss et al. Twiddler's syndrome is a rare hardware complication of implantable pulse generators (IPGs) and is most commonly described as lead retraction with implanted cardiac devices, such as pacemakers and defibrillators. Awareness of characteristic presentation and radiologic finding is essential in the identification of Twiddler's syndrome in SCS. Twiddler's syndrome in patients treated with SCS is an uncommon but important adverse event. The other patient who had a lead migration associated with coiling of the lead and twisting of pulse generator needed a revision surgery. One patient with hardware failure due to Twiddler's syndrome refused to have a revision surgery. Two cases of Twiddler's syndrome as a hardware complication of SCS were identified between 20. Considering the incidence of hardware complications of spinal cord stimulation, there may be an underreporting of Twiddler's syndrome due to lack of awareness. However, until very recently, it had not been reported in spinal cord stimulation (SCS). 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.
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