Uppal Pushpinder, Wright Thelma B, Dahbour Layth, Watterworth Blake, Lee Seung J, Gattu Kanchana, Stansbury Lynn G, Benoit Justin
Department of Anesthesiology, University of Maryland Medical Center, Baltimore, MD, USA.
Shock Trauma Associates, University of Maryland Medical Center, Baltimore, MD, USA.
Pain Rep. 2021 Aug 9;6(3):e946. doi: 10.1097/PR9.0000000000000946. eCollection 2021 Sep-Oct.
Peripheral nerve stimulators have emerged as a new generation of advanced modalities to treat chronic pain and avoid opioids. They transmit electrical stimulation through implanted leads and wireless, wearable, external generators. Common complications include infection, nerve damage, and migration of stimulating leads. This article describes 2 cases of complications from lead migration.
Case 1 describes a 61-year-old man with chronic groin pain who underwent an uncomplicated ultrasound-guided ilioinguinal peripheral nerve lead implantation. Case 2 describes a 54-year-old woman with left shoulder pain who underwent an uncomplicated ultrasound-guided percutaneous lead placement near the axillary nerve through a deltoid approach. Both peripheral nerve stimulators were confirmed with fluoroscopy, and each patient was followed up every 2 months for the following 2 years.
Both patients experienced lead migration to the skin resulting in erythema and need for lead removal. Initial unsuccessful removal by traction resulted in retained fragments and need for open surgical removal.
Neurologic complications of peripheral nerve stimulator implantation are rare, but device-associated complications, specifically lead migration, remain a source of long-term problems that can result in decreased coverage of the intended neural target.
Thorough patient education, early postimplantation assessment, and extended routine follow-up are necessary to decrease lead-associated complications. If migration does occur, the potential impact of scar tissue on removal should be considered.
外周神经刺激器已成为治疗慢性疼痛和避免使用阿片类药物的新一代先进方式。它们通过植入的导线和无线、可穿戴的外部发生器传输电刺激。常见并发症包括感染、神经损伤和刺激导线移位。本文描述了2例导线移位并发症的病例。
病例1描述了一名61岁患有慢性腹股沟疼痛的男性，他接受了一次无并发症的超声引导下髂腹股沟外周神经导线植入术。病例2描述了一名54岁患有左肩疼痛的女性，她接受了一次无并发症的超声引导下经三角肌入路在腋神经附近经皮放置导线的手术。两台外周神经刺激器均通过荧光透视确认，每位患者在接下来的2年中每2个月接受一次随访。
两名患者均出现导线移位至皮肤，导致红斑并需要取出导线。最初通过牵引取出失败，导致导线碎片残留，需要进行开放手术取出。
外周神经刺激器植入的神经并发症很少见，但与设备相关的并发症，特别是导线移位，仍然是长期问题的一个来源，可能导致预期神经靶点的覆盖范围减小。
为减少与导线相关的并发症，有必要对患者进行全面教育、植入后早期评估以及延长常规随访。如果确实发生移位，应考虑瘢痕组织对取出的潜在影响。
