Department of Pain Management, Guy's and St Thomas' Hospitals NHS Trust, London, UK
Pain Medicine, South Infirmary Victoria University Hospital, Cork, Ireland.
Reg Anesth Pain Med. 2024 May 7;49(5):332-338. doi: 10.1136/rapm-2023-104347.
Lead migration during spinal cord stimulator (SCS) trials is relatively neglected in the literature and presents a different set of challenges compared with fully implanted leads. There is no consensus on what constitutes a clinically significant amount of radiographic lead migration during SCS trials. We wished to evaluate the incidence and extent of radiographic lead migration during percutaneous SCS trials, to investigate the risk factors for lead migration and whether this has impacted on trial success.
This prospective observational study of percutaneous SCS trials took place in a tertiary referral center in the UK between April 2021 and January 2022. Radiographs of SCS lead position were taken at baseline and prior to lead removal. Lead migration ≥50% of a vertebral level was deemed significant.
One hundred trials were included comprising 162 leads. Mean migration distance was 0.55 vertebral levels (SD 0.85) or 12.5 mm (SD 18.2) in a caudal direction. Significant radiographic migration occurred in 50% of all leads (81 of 162 leads), at least one lead in 62% of cases and all leads in 44% of cases. Radiographic lead migration was not found to be associated with reduced trial success. A single lead and mechanical anchors were associated with greater incidence of lead migration.
Radiographic lead migration of approximately half of a vertebral level in a caudal direction can be expected during percutaneous SCS trials and this can be anticipated by siting leads half of a vertebral level higher to accommodate for this. Additional factors should be considered in the setting of radiographic lead migration to determine whether this can be considered clinically significant.
在脊髓刺激器 (SCS) 试验中，与完全植入的导联相比，导丝迁移相对被忽视，且呈现出不同的挑战。对于 SCS 试验中放射学导丝迁移的临床显著量，目前尚无共识。我们希望评估经皮 SCS 试验中放射学导丝迁移的发生率和程度，探讨导丝迁移的危险因素，以及这是否影响试验的成功率。
这项在英国一家三级转诊中心进行的经皮 SCS 试验前瞻性观察研究于 2021 年 4 月至 2022 年 1 月期间进行。在基线和导丝取出前拍摄 SCS 导丝位置的 X 光片。如果导丝迁移≥50%的椎体水平，则认为是显著的。
共纳入 100 例试验，共纳入 162 根导丝。平均迁移距离为 0.55 个椎体水平（标准差 0.85）或 12.5 毫米（标准差 18.2），向尾端方向。所有导丝中有 50%（81 根）、62%的病例至少有一根导丝、44%的病例所有导丝都发生了明显的放射学迁移。放射学导丝迁移与试验成功率降低无关。单根导丝和机械锚定与导丝迁移发生率增加相关。
在经皮 SCS 试验中，预计会有大约一半的椎体水平的导丝向尾端方向迁移，可以通过将导丝放置在高出一半椎体水平的位置来预测这种迁移。在出现放射学导丝迁移的情况下，应考虑其他因素，以确定这是否可以被认为具有临床意义。
