Presented at the 2012 AAPM Annual Meeting « Back

Cephalad Lead Migration Following Spinal Cord Stimulator Implantation: Technical Report

Kai McGreevy, MD, kaimcgreevy@yahoo.com¹, Chitra Ramasubbu, MD², Kayode Williams, MD MBA³, Paul Christo, MD MBA³, (1) Southeast Spine and Rehabilitation, Kingsland, Florida, (2) Johns Hopkins Medical Center, Baltimore, Maryland, (3) Johns Hopkins University School of Medicine, Baltimore, Maryland

Introduction: 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. Case Report: 60-year-old male with failed back surgery syndrome and lumbosacral radiculopathy underwent SCS lead implantation via a dual lead approach to the top of vertebral body (VB) T9. A standard strain relief loop (SRL) 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 2-week follow-up, cephalad migration to VB T1 was fluoroscopically confirmed. Results: Successful lead revision was carried out using a single paramedian incision to place extra sutures for lead security and a "figure-of-eight" SRL. Our patient derived significant pain relief (>70% on NRS) and functional improvement from SCS revision, with absence of LM confirmed by surveillance fluoroscopy at 8 weeks. Conclusion: We provide the first case report of significant cephalad LM following SCS lead implantation. This migration can occur despite the use of current standard anchoring techniques. We speculate that in addition to restabilizing the lead-anchor-fascial complex, extra SRLs in the figure-of-eight configuration may provide further protection against uncoiling and subsequent LM. Additional investigation into the mechanism of such LM and lead-securing techniques is warranted. References: 1)Mekhail NA, Mathews M, Nageeb F, Guirguis M, Mekhail MN, Cheng J. Retrospective

Funding: None