![]() ![]() It occurs when there is increased mechanical stress that overcomes the anchoring forces, allowing movement of the lead within the epidural space. Lead migration (also known as electrode migration or electrode displacement) is the unintentional displacement of SCS leads from the original location of surgical implantation with loss of SCS efficacy. Discussion Definition and Migration Rates At his most recent follow-up 3 months after revision surgery, he reported 80% pain relief and was satisfied with the outcome. His postoperative course was uncomplicated. His surgical incision was extended to find healthy, normal tissue to secure the anchors. After a thorough discussion and after informed consent was obtained, he was brought back to the operating room 4 days later and the leads were re-placed into an appropriate position. Initial management included attempted stimulation reprogramming, but the patient did not obtain significant pain relief. ![]() Imaging confirmed caudal migration of the lead tips to C7. Given the abrupt increase in his pain and the lack of outward signs of new pathology or device complications, the decision was made to obtain cervical spine x-rays to assess the lead locations. The remainder of his exam was unremarkable. He had full strength and intact sensation throughout the bilateral upper extremities and no range-of-motion deficits at the neck or upper extremities. His surgical incisions were well healed, and there were no signs of infection, including worsening pain, swelling, or erythema at the surgical sites. On the day his pain increased, the patient reported that he was very active, doing yard work and playing with his grandchildren.Ī physical exam revealed an obviously uncomfortable patient. In the clinic, he stated that his pain levels were back to baseline, similar to before SCS was performed. He had previously reported 70% pain relief with the SCS. A bi-winged manufacturer-provided anchor was incorporated to secure the leads to the fascia. ![]() During the implant procedure, a paresthesia-based system was used, and two cylindrical leads were implanted with the lead tips staggered at the C3 level. ![]() Case PresentationĪ 57-year-old man with a history of chronic left upper extremity C5–C7 radiculopathies presented to a pain clinic 2 months after implantation of a percutaneous cervical SCS with 3 days of an abrupt increase in left upper extremity pain. Thereafter, we review SCS lead migration, including symptomatology, diagnosis, and management. In the following section, we describe a case of a patient who experienced an acute loss of SCS efficacy related to lead migration. Infection (3.4–10%), epidural fibrosis (19%), neurologic injury (0.034–0.3%), and tolerance to stimulation are some biological complications that can cause loss of SCS efficacy. Device complications include lead migration (2.1–27%), lead fracture (6–10.2%), electrode disconnection from the implantable pulse generator (IPG 0.4–2.9%), and IPG failure (1.7–3%). Etiologies for loss of efficacy can be divided into either device or hardware complications or biologic complications. Patients may experience decreases in both functional status and quality of life as a result of lost therapeutic efficacy. reported an incidence of loss of efficacy of 13.7%. Loss of efficacy results in a decrease or complete loss of therapeutic stimulation or return to pain levels prior to SCS implantation. One such complication is loss of therapeutic efficacy. Although it is generally very safe, SCS implantation does have specific risks and complications. Spinal cord stimulation (SCS) is an effective nonpharmacologic modality indicated for the management of multiple chronic neuropathic pain such as failed back surgery syndrome, complex regional pain syndrome, and painful peripheral neuropathies. ![]()
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