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Radiographic lead migration in percutaneous spinal cord stimulator trials
Cormac Francis Mullins1,2, Jonathan Royds3, Adnan Al-Kaisy3
1Department of Pain Management, Guy's and St Thomas' Hospitals NHS Trust, London, UK cormacmullins1@gmail.com.
Regional Anesthesia and Pain Medicine
|July 21, 2023
Summary
Lead migration during spinal cord stimulator (SCS) trials is common, with about half of leads moving significantly. This migration did not affect trial success, but single leads and anchors increased its incidence.
Area of Science:
- Neurosurgery
- Pain Management
- Medical Device Technology
Background:
- Lead migration during spinal cord stimulator (SCS) trials is a poorly understood phenomenon.
- Unlike fully implanted leads, trial leads present unique migration challenges.
- No established criteria define significant radiographic lead migration during SCS trials.
Purpose of the Study:
- To determine the incidence and extent of radiographic lead migration during percutaneous SCS trials.
- To identify risk factors associated with lead migration.
- To assess the impact of lead migration on SCS trial success.
Main Methods:
- Prospective observational study conducted in a UK tertiary referral center.
- 100 percutaneous SCS trials (162 leads) were analyzed between April 2021 and January 2022.
- Radiographs were taken at baseline and before lead removal; migration of ≥50% of a vertebral level was considered significant.
Main Results:
- Mean lead migration was 0.55 vertebral levels (12.5 mm) caudally.
- Significant radiographic migration occurred in 50% of leads (81/162).
- Lead migration was not associated with reduced trial success; single leads and mechanical anchors correlated with higher migration rates.
Conclusions:
- Expect approximately half a vertebral level of caudal migration during SCS trials.
- Siting leads half a vertebral level higher may mitigate migration.
- Further factors need consideration to define clinical significance of radiographic lead migration.
