CEPHALAD MIGRATION OF SPINAL CORD STIMULATOR LEAD: A CASE REPORT

Authors: Luis Miguel Escano Volquez MD, Roger Haddad MD

Henry Ford Health, Detroit, Michigan /Department of Anesthesiology, Pain Management & Perioperative Medicine

 

Neuromodulation is an effective modality to treat multiple conditions.

Complication rate can be up to 40% (Lead migration remains the most common)

Mechanical stress is the primary culprit of migration.

Consequence: loss of stimulation and failure of trial.

Most of the published data document permanent implants

Consequences of failed trial are detrimental to patient outcome

 

69 years old female

PMH: HTN, T2DM, A. Fib. Chronic low back pain, BMI:23.7

Allergies: Severe allergy to adhesives

August 2020 – Trial lead placement.

Access: T12-L1 x2

Lead placement: T8 and T9

Lead securing: Tegaderm, tension relieving loops, paper tape applied over loops.

No firm adhesive tape (Stayfix) used.

Trial day #2: No relief reported. Patient advised to present to the clinic again for evaluation.

Thoracic x-ray performed showing lead migration to T3 level.

Lead was pulled back down to T8 level and four extra days of trial were offered.

<10% relief at trial day #7.

 

Lead migration continues to be the most common complication for trials and permanent implants (1.5-44%)

Not many studies documenting migration rate for trials

Many are missed due to lack of F/U x-rays

Cephalad migrations is rare

Multifactorial in origin:

Repetitive, vigorous movement

Low BMI

Anatomical reasons: levoconvex scoliosis in the patient, lumbarized S1

No Stayfix or sutures used

Negative pressure of epidural space

 

The vast majority of lead migration cases are caudad, cephalad migration is rarely encountered.

Multiple factors may have played a role

Study of the mechanism and potential alternatives for securing the lead is important.