Walton Edward, Zhitny Vladislav Pavlovich, Dixon Brett, Jannoud Ryan, Rahman Ivan
Department of Anesthesiology, Perioperative Care, and Pain Medicine, New York University, New York City, NY, USA.
Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, Las Vegas, NV, USA.
Ann Med Surg (Lond). 2025 Mar 3;87(4):2426-2429. doi: 10.1097/MS9.0000000000003104. eCollection 2025 Apr.
Spinal cord stimulator (SCS) implantation has become a well-validated treatment for refractory chronic back pain. While generally safe, complications such as lead migration and postdural puncture headache (PDPH) can arise. Recognizing these hardware and biologic complications is crucial to improving outcomes and guiding management strategies.
A middle-aged male with chronic nocturnal cough underwent successful percutaneous SCS trial placement under fluoroscopic guidance. Adequate pain coverage was confirmed, and he was discharged home. The following day, he returned with a positional headache, nausea, and imaging-confirmed lead migration. PDPH was suspected. At the time of presentation, a chest X-ray revealed possible lead migration, and the patient had also reported a chronic dry cough that had worsened the evening of the procedure. Management included removal of the leads and an epidural blood patch, leading to complete symptom resolution.
Nocturnal coughing is hypothesized to have caused mechanical stress on the SCS leads, resulting in caudal migration. Lead migration is one of the most common SCS complications, with rates of 2.1-27%. Additionally, PDPH, though rare (~0.81% per lead placed), often requires an epidural blood patch for effective resolution. In this case, the displaced leads may have exacerbated an underlying dural tear, highlighting a novel interplay between hardware and biological complications.
This is the first documented case at our academic center of concurrent lead migration and PDPH following SCS placement. Our findings suggest that chronic coughing may represent an unrecognized risk factor for lead migration and PDPH. Providers should address unresolved coughing prior to SCS implantation and consider improved anchoring techniques to minimize risks.
脊髓刺激器（SCS）植入已成为一种经过充分验证的难治性慢性背痛治疗方法。虽然总体安全，但可能会出现诸如导线移位和硬膜穿刺后头痛（PDPH）等并发症。认识到这些硬件和生物并发症对于改善治疗效果和指导管理策略至关重要。
一名患有慢性夜间咳嗽的中年男性在透视引导下成功进行了经皮SCS试验性植入。确认疼痛得到充分缓解后，他出院回家。第二天，他因体位性头痛、恶心返回，影像学检查证实导线移位。怀疑是PDPH。就诊时，胸部X线显示可能存在导线移位，患者还报告慢性干咳在手术当晚加重。治疗措施包括取出导线和进行硬膜外血贴，症状完全缓解。
推测夜间咳嗽对SCS导线造成了机械应力，导致尾端移位。导线移位是最常见的SCS并发症之一，发生率为2.1%-27%。此外，PDPH虽然罕见（每植入一根导线发生率约为0.81%），但通常需要进行硬膜外血贴才能有效缓解。在本病例中，移位的导线可能加剧了潜在的硬膜撕裂，突显了硬件和生物并发症之间的一种新的相互作用。
这是我们学术中心记录的首例SCS植入后并发导线移位和PDPH的病例。我们的研究结果表明，慢性咳嗽可能是导线移位和PDPH的一个未被认识的危险因素。在植入SCS之前，医疗人员应处理未解决的咳嗽问题，并考虑改进固定技术以降低风险。
