Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA.
Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.
Neuromodulation. 2022 Jul;25(5):731-737. doi: 10.1111/ner.13487. Epub 2021 Jul 2.
Lead migration after spinal cord stimulator (SCS) implant is a commonly reported complication and the most common reason for revision surgery in cases of loss of efficacy. The primary aims of this study are to describe the incidence and degree of lead migration in the subacute postoperative period after SCS implant and to report potential risk factors for lead migration.
We performed a retrospective chart review of all patients at a single academic center who received an SCS implant from January 1, 2020, to December 31, 2020. Information on patient (age, sex, weight, and height) and operative factors (device manufacturer, epidural access level and method, and implantable pulse generator location) were extracted from medical records. Intraoperative imaging was compared to subacute follow-up imaging obtained less than 20 days postimplant to measure lead migration distance. Regression models were fitted to determine associations between lead migration distance and potential clinical risk factors.
A total of 91 cases (182 leads) were included in the study. Within 20 days of implantation, 88.5% of leads had migrated (86.3% caudal and 2.2% cephalad). Mean migration distance for leads with caudal migration only was 12.34 ± 12.19 mm based on anteroposterior radiographs and 16.95 ± 15.68 mm on lateral radiographs. There was an association of greater caudal lead migration as patient body mass index increased (β-coefficient 0.07 [95% confidence interval 0.01-0.13], p = 0.031). Within the entire cohort, one patient (1.1%) required lead revision for loss of efficacy.
In the subacute postoperative period after SCS implant, the majority of SCS leads migrated caudally with an average of two lead contacts. Knowledge of this expected migration and risk factors can better inform implanting physicians intraoperatively when deciding final lead placement location. The finding of high likelihood of caudal lead migration in the subacute postoperative period brings the need for a well-designed prospective study to the forefront of our field. This will allow implanting providers to make well-informed decisions for intraoperative lead placement.
脊髓刺激器（SCS）植入后电极移位是一种常见的并发症，也是疗效丧失时进行翻修手术的最常见原因。本研究的主要目的是描述 SCS 植入后亚急性术后阶段电极移位的发生率和程度，并报告电极移位的潜在危险因素。
我们对 2020 年 1 月 1 日至 12 月 31 日在单家学术中心接受 SCS 植入的所有患者进行了回顾性图表审查。从病历中提取患者（年龄、性别、体重和身高）和手术因素（设备制造商、硬膜外入路水平和方法以及可植入脉冲发生器位置）的信息。将术中影像与植入后不到 20 天获得的亚急性随访影像进行比较，以测量电极移位距离。拟合回归模型以确定电极移位距离与潜在临床危险因素之间的关联。
共纳入 91 例（182 个电极）。植入后 20 天内，88.5%的电极发生了移位（86.3%为尾部，2.2%为头部）。仅尾部移位的电极的平均移位距离为前后位 X 线片上的 12.34±12.19mm 和侧位 X 线片上的 16.95±15.68mm。随着患者体重指数的增加，尾部电极的迁移量更大（β系数 0.07[95%置信区间 0.01-0.13]，p=0.031）。在整个队列中，有 1 名患者（1.1%）因疗效丧失需要进行电极翻修。
在 SCS 植入后的亚急性术后阶段，大多数 SCS 电极向尾部迁移，平均有两个电极接触。了解这种预期的迁移和危险因素可以在术中为植入医生提供更好的信息，以便在决定最终电极放置位置时做出明智的决策。亚急性术后阶段极有可能发生尾部电极迁移的发现使我们迫切需要进行一项精心设计的前瞻性研究，以推进我们这一领域的发展。这将使植入提供者能够为术中电极放置做出明智的决策。
