AI Article Synopsis
- Spinal cord stimulation (SCS) trial periods often experience lead migration, which can negatively affect pain management outcomes for patients.
- Significant lead migration tends to happen early in the trial, specifically on postoperative days 1 or 2, suggesting that adjustments could be made to enhance therapeutic effectiveness.
- A study involving 27 patients revealed that 74% experienced clinically significant lead migration, with an average movement of around 18-19 mm shortly after implantation.
Article Abstract
Background: Spinal cord stimulation (SCS) devices are routinely trialed to assess pain and functional improvement before permanent lead implantation. Lead migration is a common complication that may cause a loss of therapeutic effect in patients who may otherwise benefit from SCS. The timing of lead migration during the trial period is currently unknown.
Objectives: We hypothesize that significant lead migration may occur early in the SCS trial period, such as postoperative day 1 or 2, which may allow for contact stimulation adjustment to prevent false negative trial results. As such, in this study, we aim to evaluate the incidence and distance of lead migration in early thoracic SCS trial period.
Methods: We performed a case series of 27 patients ≥19 years of age who received differential target multiplexed thoracic SCS trials for chronic neuropathic pain from July 1, 2020 to July 1, 2023. Patients with a neuropathic pain diagnosis failing medical treatment, without structural pathology limiting epidural access, and with psychiatric clearance for suitability are eligible for SCS trials at our center. Pre- and post-flexion radiographs taken immediately after implantation and on postoperative day 1 or 2 were examined to assess the distance of lead migration. Clinically significant lead migration was pre-defined as ≥ 10 mm.
Results: The mean (SD) distances of epidural lead migration on postoperative day 1 or 2 were 18.2 (12.9) mm and 19.1 (13.3) mm for the cephalic and caudal leads, respectively. All migrations were caudad except for one trial. Clinically significant lead migration occurred in 20/27 (74 %) patients.
Conclusion: Clinically significant epidural lead migration occurs in the early SCS trial period.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536288 | PMC |
| http://dx.doi.org/10.1016/j.inpm.2024.100426 | DOI Listing |
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