BACKGROUND: Spinal cord stimulation (SCS) is an emerging therapeutic intervention for intractable chronic pain. However, SCS surgery is not exempt from complications such as lead migration, infections, hardware malfunction and neurological deficits.

CASE REPORT: We present this case report on bilateral abducens nerve palsy, as a rare iatrogenic complication of SCS system insertion in a 65-year-old man with intractable chronic pain. After failing conservative treatment and explant, he underwent corrective strabismus surgery and achieved symptom control.

CONCLUSION: The case presents a diagnostic and management challenge due to the nature of his presentation, neuroimaging pitfalls and limited high-quality evidence for management. We recognise cranial nerve palsy as a potential, yet real, complication of SCS surgery, of which abducens nerve palsy presents significant detriment to patients lives. As SCS continues to expand in clinical practice, inevitably, so will its iatrogenic sequela signalling the need for greater recognition and formation high-quality evidence for efficacious management.

KEYWORDS: Spinal cord stimulation insertion, abducens nerve palsy, case report, chronic pain