Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
World Neurosurg. 2019 Aug;128:e649-e652. doi: 10.1016/j.wneu.2019.04.225. Epub 2019 May 1.
Neuromodulation is an evolving therapy for chronic pain. Aiming to meet the limitations of traditional spinal cord stimulation, dorsal root ganglion (DRG) stimulation targets pain in a dermatomal distribution at the site of pain transmission. Despite these advantages, lead migration is a significant complication that hinders the long-term efficacy of DRG stimulation. This study aims to identify risk factors for lead migration requiring revision in DRG stimulation.
We performed a retrospective review of all subjects who had DRG stimulators implanted at T10-S2 by a single physician over a 2-year period. Their history was reviewed for the following: age, sex, diagnosis, lead placement, reported symptom relief, complications, and postoperative activity.
In total, 19 cases of DRG stimulator implantation were identified. All patients reported pain relief, with 84.2% (16/19) describing >50% relief. In total, 31.6% of patients (6/19) developed lead migration and 15.8% of total implanted leads (9/57) migrated. Of the migrated leads, 4% (4/9) occurred at S1 and 33.3% (3/9) occurred at L4. The underlying etiology of lead migration was clear and preventable in 66.7% of patients (4/6). All patients who developed lead migration were women.
Premature activity, hardware manipulation, and female sex appear to be associated with an increased risk for lead migration. Leads on the S1 and L4 locations may be more likely to migrate. Large trials are necessary to gain a more conclusive understanding of these risk factors for lead migration.
神经调节是一种用于治疗慢性疼痛的新兴疗法。与传统的脊髓刺激相比，背根神经节（DRG）刺激旨在针对疼痛传输部位的皮肤节段分布的疼痛。尽管具有这些优势，但导丝迁移仍是一个重大并发症，会阻碍 DRG 刺激的长期疗效。本研究旨在确定需要对 DRG 刺激进行修正的导丝迁移的危险因素。
我们对一位医生在 2 年内于 T10-S2 植入 DRG 刺激器的所有患者进行了回顾性研究。回顾了他们的病史，包括年龄、性别、诊断、导丝放置、报告的症状缓解、并发症和术后活动情况。
共确定了 19 例 DRG 刺激器植入病例。所有患者均报告疼痛缓解，其中 84.2%（16/19）患者的缓解程度>50%。共有 31.6%（6/19）的患者出现导丝迁移，总植入导丝的 15.8%（9/57）发生迁移。在迁移的导丝中，4%（4/9）发生在 S1，33.3%（3/9）发生在 L4。导丝迁移的根本病因在 66.7%（4/6）的患者中是明确且可预防的。发生导丝迁移的所有患者均为女性。
过早活动、硬件操作和女性性别似乎与导丝迁移的风险增加有关。S1 和 L4 位置的导丝可能更容易迁移。需要进行大型试验以更清楚地了解这些导丝迁移的危险因素。
