Song Wendy Han Cong, Jen Tim Ting Han, Osborn Jill Alison, Varshney Vishal
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada.
Interv Pain Med. 2024 Jul 16;3(3):100426. doi: 10.1016/j.inpm.2024.100426. eCollection 2024 Sep.
Spinal cord stimulation (SCS) devices are routinely trialed to assess pain and functional improvement before permanent lead implantation. Lead migration is a common complication that may cause a loss of therapeutic effect in patients who may otherwise benefit from SCS. The timing of lead migration during the trial period is currently unknown.
We hypothesize that significant lead migration may occur early in the SCS trial period, such as postoperative day 1 or 2, which may allow for contact stimulation adjustment to prevent false negative trial results. As such, in this study, we aim to evaluate the incidence and distance of lead migration in early thoracic SCS trial period.
We performed a case series of 27 patients ≥19 years of age who received differential target multiplexed thoracic SCS trials for chronic neuropathic pain from July 1, 2020 to July 1, 2023. Patients with a neuropathic pain diagnosis failing medical treatment, without structural pathology limiting epidural access, and with psychiatric clearance for suitability are eligible for SCS trials at our center. Pre- and post-flexion radiographs taken immediately after implantation and on postoperative day 1 or 2 were examined to assess the distance of lead migration. Clinically significant lead migration was pre-defined as ≥ 10 mm.
The mean (SD) distances of epidural lead migration on postoperative day 1 or 2 were 18.2 (12.9) mm and 19.1 (13.3) mm for the cephalic and caudal leads, respectively. All migrations were caudad except for one trial. Clinically significant lead migration occurred in 20/27 (74 %) patients.
Clinically significant epidural lead migration occurs in the early SCS trial period.
脊髓刺激（SCS）装置在永久性电极植入前通常会进行试验，以评估疼痛和功能改善情况。电极移位是一种常见并发症，可能导致原本可能从SCS中获益的患者失去治疗效果。目前尚不清楚试验期内电极移位的时间。
我们假设在SCS试验期早期，如术后第1天或第2天，可能会发生显著的电极移位，这可能允许进行接触刺激调整，以防止试验结果出现假阴性。因此，在本研究中，我们旨在评估早期胸段SCS试验期电极移位的发生率和移位距离。
我们对2020年7月1日至2023年7月1日期间接受差异靶点多重胸段SCS试验治疗慢性神经性疼痛的27例年龄≥19岁的患者进行了病例系列研究。患有经药物治疗无效的神经性疼痛诊断、无限制硬膜外穿刺的结构病理学问题且经精神科评估适合的患者，有资格在我们中心进行SCS试验。在植入后立即以及术后第1天或第2天拍摄的前屈和后屈X线片用于评估电极移位的距离。临床上显著的电极移位预先定义为≥10毫米。
术后第1天或第2天，头端和尾端硬膜外电极移位的平均（标准差）距离分别为18.2（12.9）毫米和19.1（13.3）毫米。除一次试验外，所有移位均为尾侧移位。20/27（74%）例患者发生了临床上显著的电极移位。
临床上显著的硬膜外电极移位发生在SCS试验早期。
