Images in Practice: Successful Recapture of Spinal Cord Stimulator Paresthesia Coverage via Generator Reprogramming in a Patient with a Severely Displaced Percutaneous Trial Lead (original) (raw)
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Cephalad Lead Migration Following Spinal Cord Stimulation Implantation
Pain Physician, 2012
Lead migration (LM) is the most common complication after spinal cord stimulation (SCS). Although multiple reports of caudad LM have been described, cephalad LM has not been reported. Here we describe a case in which a stimulator lead migrates in the cephalad direction. A 60-year-old male with failed back surgery syndrome underwent SCS lead implantation via a dual lead approach to the top of vertebral body (VB) T9. A standard strain relief loop was used for each lead in the paramedian pocket. Postoperative testing revealed 100% paresthesia coverage of the painful areas. For the first 4 days, the patient continued to have excellent coverage; however, by the seventh day, the paresthesias ascended to above the nipple line. At the 2-week follow-up, cephalad migration of the left lead to the top of VB T1 was confirmed on fluoroscopy. The patient underwent successful lead revision in which a single paramedian incision technique was used to place extra sutures and a “figure-of-eight” strai...
Surgical Neurology International, 2021
Background: Lead migration is a complication associated with occipital nerve stimulation (ONS). We present a rare case in which fibrosis in the stress relief loop caused lead migration in the treatment of occipital neuralgia. Case Description: A 30-year-old woman with a 5-year history of refractory occipital neuralgia, who had been under ONS therapy for 2 months, presented with a sudden onset of typical occipital neuralgia pain associated with cervical muscles spasms and myoclonus. A skull radiography showed lead migration. The patient underwent surgery for lead repositioning. During surgery, we identified extensive fibrosis throughout the stress relief loop that produced several constriction points. The fibrosis in the stress relief loop increased tension on the lead during head-and-neck movement, causing progressive migration of the lead. Conclusion: Although lead migration is a common complication of ONS, its association with fibrosis in the stress relief loop has not, to the bes...
Journal of Clinical Neuroscience, 2018
The incidence of symptomatic percutaneous intrathecal subarachnoid lead placement for spinal cord stimulator is almost an unheard of complication in the literature. We present the first case of a spinal cord stimulator implant with a complication of symptomatic intrathecal subarachnoid lead placement with a pseudomeningocele. This complication was found with myelogram and addressed by replacement with a new spinal cord stimulator implant with paddle leads instead of percutaneous leads and obliterating the pseudomeningocele tract. Technique for epidural lead placement is discussed. This case illustrates a spinal cord stimulator implant complication of intrathecal percutaneous lead placement with pseudomeningocele and its recognition and treatment involving replacement of the system while minimizing risk of postoperative cerebrospinal fluid leakage. Intraoperative neuromonitoring and interrogation of the spinal cord stimulator system during implantation are effective tools for accurate epidural lead placement.
Percutaneous Spinal Cord Stimulation Lead Placement Under Deep Sedation and General Anesthesia
Pain and Therapy, 2021
Introduction: Spinal cord stimulation (SCS) is a commonly utilized therapy for the treatment of neuropathic pain conditions. The Neurostimulation Appropriateness Consensus Committee (NACC) has recommended that the placement of percutaneous SCS leads be performed in an awake patient capable of providing feedback. It is not currently known how commonly this recommendation is adhered to by physicians in clinical practice. This article presents the findings of a survey designed to answer this important question. Methods: We conducted a survey of the active membership of the American Society of Regional Anesthesia and Pain Medicine (ASRA) and the Spine Intervention Society (SIS) regarding practice patterns with SCS therapy. We analyzed the percent of respondents who indicated that they use deep sedation and general anesthesia during SCS placement as well as any reported complications. Results: Many practitioners frequently utilize deep sedation as well as general anesthesia when performing SCS implants. Our findings demonstrate that 77% of physicians reported that they utilize deep sedation for permanent SCS implants at times, and 45% of physicians
Lodged Spinal Cord Stimulator Trial Lead: A Case Report
Pain Practice, 2008
▪ Abstract: We present a case report in which spinal cord stimulator trial lead became lodged in the posterior lumbar soft tissue. The lead could not be removed even with moderate force or with spine in the flexed position. Radiologic evaluation revealed that edge of metallic lead was wedged into the soft tissue. We were able to remove the lead only after placing the patient in an extreme tuck position (knee-to-chest); thus possibly avoiding surgical intervention. ▪
PLOS ONE
pdf). The funders had no role in study design, data indices were collected and analyzed. Clinical outcomes were characterized with validated rating scales for all cases, and a comparison was made between outcomes of cases with lead migration versus those where migration of the lead did not occur. Results Data from 138 leads in 132 patients with initial and delayed lead localization CT scans were analyzed. The mean distance between initial and delayed DBS lead tip position was 2.2 mm and the mean change in intracranial lead length was 0.45 mm. Significant delayed migration (>3 mm) was observed in 17 leads in 16 patients (12.3% of leads, 12.1% of patients). Factors associated with lead migration were: technical error, repetitive dystonic head movement, and twiddler's syndrome. Outcomes were worse in dystonia patients with lead migration (p = 0.035). In the PD group, worse clinical outcomes trended in cases with lead migration. Conclusions Over 10% of DBS leads in this large single center cohort were displaced by greater than 3 mm on delayed measurement, adversely affecting outcomes. Multiple risk factors emerged, including technical error during implantation of the DBS pulse generator and failure of lead fixation at the burr hole site. We hypothesize that a change in surgical technique and a more effective lead fixation device might mitigate this problem.
Neuromodulation: Technology at the Neural Interface, 2021
Objectives: Spinal cord stimulation (SCS) is an effective therapy for chronic intractable pain. Conventional SCS involves electrode placement based on intraoperative paresthesia mapping; however, newer paradigms like burst may allow for anatomic placement of leads. Here, for the first time, we report the one-year safety and efficacy of burst SCS delivered using a lead placed with conventional, paresthesia mapping, or anatomic placement approach in subjects with chronic low back pain (CLBP). Materials and Methods: Subjects with CLBP were implanted with two leads. The first lead was placed to cross the T8/T9 disc and active contacts for this lead were chosen through paresthesia mapping. The second lead was placed at the T9/T10 spinal anatomic landmark. Subjects initially underwent a four-week, double-blinded, crossover trial with a two-week testing period with burst SCS delivered through each lead in a random order. At the end of trial period, subjects expressed their preference for one of the two leads. Subsequently, subjects received burst SCS with the preferred lead and were followed up at 3, 6, and 12 months. Pain intensity (visual analog scale), quality-of-life (EuroQol-5D instrument), and disability (Oswestry Disability Index) were evaluated at baseline and follow-up. Results: Forty-three subjects successfully completed the trial. Twenty-one preferred the paresthesia mapping lead and 21 preferred the anatomic placement lead. Anatomic placement lead was activated in one subject who had no preference. The pain scores (for back and leg) significantly improved from baseline for both lead placement groups at all follow-up time points, with no significant between-group differences. Conclusions: This study demonstrated that equivalent clinical benefits could be achieved with burst SCS using either paresthesia mapping or anatomic landmark-based approaches for lead placement. Nonparesthesia-based approaches, such as anatomic landmark-based lead placement investigated here, have the potential to simplify implantation of SCS and improve current surgical practice.
Postoperative Displacement of Deep Brain Stimulation Electrodes Related to Lead-Anchoring Technique
2013
BACKGROUND: Displacement of deep brain stimulation (DBS) electrodes may occur after surgery, especially due to large subdural air collections, but other factors might contribute. OBJECTIVE: To investigate factors potentially contributing to postoperative electrode displacement, in particular, different lead-anchoring techniques. METHODS: We retrospectively analyzed 55 patients (106 electrodes) with Parkinson disease, dystonia, tremor, and obsessive-compulsive disorder in whom early postoperative and long-term follow-up computed tomography (CT) was performed. Electrodes were anchored with a titanium microplate or with a commercially available plastic cap system. Two independent examiners determined the stereotactic coordinates of the deepest DBS contact on early postoperative and long-term follow-up CT. The influence of age, surgery duration, subdural air volume, use of microrecordings, fixation method, follow-up time, and side operated on first was assessed. RESULTS: Subdural air collections measured on average 4.3 6 6.2 cm 3 . Three-dimensional (3-D) electrode displacement and displacement in the X, Y, and Z axes significantly correlated only with the anchoring method, with larger displacement for microplate-anchored electrodes. The average 3-D displacement for microplate-anchored electrodes was 2.3 6 2.0 mm vs 1.5 6 0.6 mm for electrodes anchored with the plastic cap (P = .030). Fifty percent of the microplate-anchored electrodes showed 2-mm or greater (potentially relevant) 3-D displacement vs only 25% of the plastic cap-anchored electrodes (P , .01). CONCLUSION: The commercially available plastic cap system is more efficient in preventing postoperative DBS electrode displacement than titanium microplates. A reliability analysis of the electrode fixation is warranted when alternative anchoring methods are used.
Lead Fractures in Deep Brain Stimulation during Long-Term Follow-Up
Parkinson's Disease, 2010
The purpose was to determine the incidence of lead fracture in patients with DBS over a long period of time. We present a retrospective study of 208 patients who received 387 DBS electrodes. Fourteen patients had sixteen lead fractures (4% of the implanted leads) and two patients suffered from 2 lead fractures. Of all lead fractures, five patients had the connection between the leads and the extension cables located in mastoids region, ten in cervical area and one in thoracic region. The mean distance from the connection between the electrode and the extension cable and the lead fracture was 10.7 mm. The lead fracture is a common, although long-term complication in DBS surgery. In our experience, the most common site of electrode cable breakage is approximately between 9 and 13 mm from the junction between the lead and the extension cable. The most important cause of lead fracture is the rotational movement of the lead-extension cable system. If we suspect lead fracture, we must check the impedance of the electrode and to evaluate the side effects of voltage. Finally, we must conduct a radiological screening.
Cureus, 2022
Spinal Cord Stimulators (SCS) are a nonpharmacologic chronic pain management treatment modality that is well-validated and cost-effective within the surgeon's armamentarium. The reported complication rates are between 5.3% to 40%, most commonly secondary to mechanical hardware failure. The most common mechanical complication is lead migration, which necessitates second surgery. The purpose of this technical note is to describe a minimally invasive spine surgery (MISS) implantation technique we believe to be more resilient to lead migration. We present a stepwise technique for SCS implantation with a maxillofacial screw and washer failsafe.