2020 FSA Posters

P054: REDUCING SPINAL CORD STIMULATOR LEAD MIGRATION WITH STRAIN RELIEF
Colby Skinner, MD; Ajay Antony, MD; University of Florida Department of Anesthesiology

Introduction and Background: Spinal cord stimulator (SCS) placement is a safe and effective minimally invasive intervention to reduce or eliminate intractable pain of the trunk and limbs (1). Incidence estimates for lead migration after permanent lead placement range from 13.2% (4) to 22.6% (5). Migration after permanent implant can lead to a decrease or loss of therapeutic effect, which may subsequently require surgical revision or removal and can result in high, avoidable, health care costs (9). Thus, minimizing SCS lead migration is crucial.  Various anchoring devices and techniques have been developed for both the trial and permanent implant to minimize lead migration. A vast majority of implanters do not use a traditional anchoring device, but instead follow what is currently considered best practice – placing superior and inferior leads in the epidural space using a specialized sheath delivery system (12).

Dorsal root ganglion (DRG) stimulation been increasingly used as a form of neurostimulation. Instead of placing leads in the posterior epidural space, DRG leads are placed in the neural foramen to treat CRPS type one or type two in the lower extremities. Using the principle of strain relief in the epidural space seen with routine DRG stimulation, we present using this concept for dorsal column lead placement to decrease percutaneous lead migration that augments routine anchoring done with permanent implantation of SCS leads.

Methods: SCS leads are typically placed under intermittent and live fluoroscopy in the epidural space of the thoracic or cervical spine depending on the distribution of a patient’s pain (1). After lead placement in the posterior epidural space, the stylet of the lead is withdrawn halfway. The less rigid lead is then advanced using live fluoroscopy, paying special attention to the lead as it exits the Touhy needle. This technique creates strain relief near the site of needle entry while preserving the distal location of the SCS contacts. The proceduralist must be mindful to fully withdrawal the stylet or the distal portion of the lead will likely advance. Also, we note that too much strain relief has the potential to encroach on the far lateral nerve roots, which has the potential to cause irritation.

Results: Five patients underwent this SCS lead anchoring technique over the past year. To date, no lead migration has occurred in any of the patients. Each of the five patients received and continues to experience 100% post-procedure pain relief. There have been no other complications related to the procedure.

Discussion: The aforementioned anchoring technique has been used in a limited number of patients to date to reduce SCS lead migration rates – the most common complication associated with SCS and DRG lead placement. Our method of strain relief has been shown to be safe and effective in our limited participant pool. We anticipate expanding this method to additional patients undergoing SCS implantation. While preliminary observational analysis of current patients is promising, future prospective studies are needed to fully assess the efficacy and safety of our technique.