Lead migration in spinal cord stimulation is the most common complication associated with percutaneous spinal cord stimulator implantation.[1] This is generally discovered when patients experience loss of their pain coverage or difficulty with programming, which leads to imaging studies demonstrating a lead migration.[2] This case provides radiographic evidence of lead migration that was discovered in a 63-year-old male who had a spinal cord stimulator placed for complex regional pain syndrome (CRPS). The patient initially had 75% pain relief on initial implantation which dropped to 25% at a 1-month follow-up. His pain relief remained at 25% at his 2-month follow-up despite reprogramming. This prompted imaging studies to evaluate for lead migration. The images below demonstrate the left lead migrated from the superior border of the T9 end plate to the middle of T10. The patient was able to be reprogrammed with this information and regained good coverage from his spinal cord stimulator implant [Figures 1 and 2]. It is important to suspect lead migration when patients lose coverage after implantation. Risk factors for migration include obesity, postoperative activity, and surgical technique. There may be some benefit in utilizing certain surgical techniques for lead securement.[3] Pain physicians should have a low threshold to image patients who present with acute loss of pain coverage.
Figure 1.
Anteroposterior radiographs of the initial intraoperative imaging demonstrating successful lead placement spanning T8 and T9 vertebrae
Figure 2.
Anteroposterior radiographs at follow-up demonstrating significant left lead caudal migration to T10 vertebrae
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
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References
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