First Report of Extraspinal Lead Migration Along a Thoracic Spinal Nerve After Spinal Cord Stimulation.
Extraspinal
Failed back surgery syndrome
Lead migration
Spinal cord stimulation
Spinal nerve
Thoracic nerve root chronic pain
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
received:
28
04
2020
revised:
04
06
2020
accepted:
06
06
2020
pubmed:
17
6
2020
medline:
8
1
2021
entrez:
17
6
2020
Statut:
ppublish
Résumé
Spinal cord stimulation for failed back surgery syndrome and chronic pain is a well-established treatment regimen today. Lead migration is the most common complication; mainly epidural caudal more than cranial electrode migration from the primary position is described repeatedly throughout the literature. A 60-year-old male patient with failed back surgery syndrome was eligible for spinal cord stimulation. Surgery had been performed 4 weeks before readmission with proper lead positioning of both electrodes in the midline of the epidural space. The electrode fixation mechanism at L2/3 had to be revised and was replaced with multiple ligature fixations due to the patient's slim build. He presented to our outpatient clinic with thoracic right-sided pain matching T5 with signs of overstimulation of the paravertebral muscles. X-ray imaging revealed cranial migration of 1 lead to T4 and a right-sided extraspinal migration of the other lead along a spinal nerve in T5 exiting the neuroforamen and following beneath the corresponding rib dorsally. Revision surgery was performed using a thoracic paddle electrode. Lead migration remains a challenge in spinal cord stimulation regardless of the fixation method. Rare unusual migration patterns in addition to simple caudal or cranial migration might pose a challenge for revision surgery and thus might reduce overall treatment efficacy.
Sections du résumé
BACKGROUND
Spinal cord stimulation for failed back surgery syndrome and chronic pain is a well-established treatment regimen today. Lead migration is the most common complication; mainly epidural caudal more than cranial electrode migration from the primary position is described repeatedly throughout the literature.
CASE DESCRIPTION
A 60-year-old male patient with failed back surgery syndrome was eligible for spinal cord stimulation. Surgery had been performed 4 weeks before readmission with proper lead positioning of both electrodes in the midline of the epidural space. The electrode fixation mechanism at L2/3 had to be revised and was replaced with multiple ligature fixations due to the patient's slim build. He presented to our outpatient clinic with thoracic right-sided pain matching T5 with signs of overstimulation of the paravertebral muscles. X-ray imaging revealed cranial migration of 1 lead to T4 and a right-sided extraspinal migration of the other lead along a spinal nerve in T5 exiting the neuroforamen and following beneath the corresponding rib dorsally. Revision surgery was performed using a thoracic paddle electrode.
CONCLUSIONS
Lead migration remains a challenge in spinal cord stimulation regardless of the fixation method. Rare unusual migration patterns in addition to simple caudal or cranial migration might pose a challenge for revision surgery and thus might reduce overall treatment efficacy.
Identifiants
pubmed: 32540296
pii: S1878-8750(20)31320-6
doi: 10.1016/j.wneu.2020.06.062
pii:
doi:
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
247-250Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.