Impact of Tunneling on Lead Migration in Peripheral Nerve Stimulation: A Retrospective Cohort Study

Peripheral nerve stimulation (PNS) has emerged as an important modality for treating focal chronic pain, offering targeted analgesia with minimally invasive approaches. However, complications such as lead migration may compromise treatment efficacy. Although lead anchoring is common in spinal cord and dorsal root ganglion stimulation, its role in PNS, specifically regarding tunneled vs nontunneled leads, remains insufficiently explored in current literature.

This study aimed to evaluate and compare the incidence of lead migration between tunneled and nontunneled PNS leads and to identify patient and procedural factors associated with migration.

We conducted a retrospective cohort study in 91 patients who underwent PNS lead placement at a single institution. Patient demographics, diagnoses, lead placement characteristics, and outcomes were collected. Comparisons between patients with tunneled and nontunneled treatment were conducted using the Wilcoxon rank sum test for continuous variables and χ² test/Fisher exact test for categorical variables, respectively. Multivariable logistic regression was performed to identify factors associated with migration.

Of 91 patients, 59 received nontunneled leads, and 32 received tunneled leads. Overall lead migration occurred in 16 patients (17.6%), with higher rates in nontunneled than in tunneled leads (23.7% vs 6.3%, p = 0.0447). Patients who experienced migration were younger (mean age 50.6 vs 69.7 years, p < 0.0001) and had a higher body mass index (BMI) (36.5 vs 27.7, p < 0.0001). Multivariable analysis showed that tunneling (p = 0.63) was not a significantly associated factor to migration after adjusting for age and BMI, whereas younger age (odds ratio [OR] 0.837, 95% CI 0.754-0.929, p = 0.0008) and higher BMI (OR 1.276, 95% CI 1.082-1.505, p = 0.0037) were significantly associated with migration risk.

Lead migration appeared more frequently in patients who were younger and those with higher BMI in this cohort. Although tunneling was associated with lower migration rates in the univariate analysis, this association did not persist after adjustment for patient factors in multivariable modeling. These preliminary observations suggest that patient characteristics may play a more influential role than tunneling technique, and that further prospective research is necessary to clarify whether tunneling may offer added benefit.