Cephalad extraspinal migration of percutaneously implanted spinal cord stimulator electrodes

Abstract

Background: Spinal cord stimulation (SCS) is an invasive but beneficial treatment option for patients suffering from chronic pain. Although highly therapeutic, there are some complications that may arise. The most morbid of which is lead migration from the original implantation site. Lead migration has been demonstrated to present with neuropathy or neuralgia due to electrical stimulation of relevant structures. Disruption or migration of SCS devices subsequently has a plethora of consequences, including invasive and costly removal or replacement, decreased efficacy, and even brain injury. Case description: A 66-year old woman with a history of chronic left leg and lower back pain underwent percutaneous implantation of a spinal cord stimulator. The patient reported up to 80% pain relief in the first 6 weeks post-implantation, but began to experience decreasing efficacy and uncomfortable paraesthesias in her chest and neck. Computed tomography (CT) demonstrated that the previously implanted thoracic leads had migrated cephalad and exited the spine via the upper thoracic foraminae. Surgery was performed to remove the electrodes and place a paddle electrode. Conclusions: Spinal cord stimulation is a relatively safe and effective treatment for chronic back pain. Migration of percutaneously placed electrodes is a common complication and can result in therapeutic failure. Here we report the first case of cephalad extraspinal migration.

Keywords

• Spinal cord stimulator
• Extraspinal migration
• Cephalad migration