Objective

Lead migration after spinal cord stimulator (SCS) implant is a commonly reported complication and the most common reason for revision surgery in cases of loss of efficacy. The primary aims of this study are to describe the incidence and degree of lead migration in the subacute postoperative period after SCS implant and to report potential risk factors for lead migration.

Materials and Methods

We performed a retrospective chart review of all patients at a single academic center who received an SCS implant from January 1, 2020, to December 31, 2020. Information on patient (age, sex, weight, and height) and operative factors (device manufacturer, epidural access level and method, and implantable pulse generator location) were extracted from medical records. Intraoperative imaging was compared to subacute follow-up imaging obtained less than 20 days postimplant to measure lead migration distance. Regression models were fitted to determine associations between lead migration distance and potential clinical risk factors.

Results

A total of 91 cases (182 leads) were included in the study. Within 20 days of implantation, 88.5% of leads had migrated (86.3% caudal and 2.2% cephalad). Mean migration distance for leads with caudal migration only was 12.34 ± 12.19 mm based on anteroposterior radiographs and 16.95 ± 15.68 mm on lateral radiographs. There was an association of greater caudal lead migration as patient body mass index increased (β-coefficient 0.07 [95% confidence interval 0.01–0.13], p = 0.031). Within the entire cohort, one patient (1.1%) required lead revision for loss of efficacy.

Conclusions

In the subacute postoperative period after SCS implant, the majority of SCS leads migrated caudally with an average of two lead contacts. Knowledge of this expected migration and risk factors can better inform implanting physicians intraoperatively when deciding final lead placement location. The finding of high likelihood of caudal lead migration in the subacute postoperative period brings the need for a well-designed prospective study to the forefront of our field. This will allow implanting providers to make well-informed decisions for intraoperative lead placement.

中文翻译：

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脊髓刺激器导线迁移的发生率和风险因素，无论是否失去功效：对 91 例连续胸导联植入物的回顾性审查

客观的

脊髓刺激器 (SCS) 植入后的导线迁移是一种常见的并发症，也是在失去疗效的情况下进行翻修手术的最常见原因。本研究的主要目的是描述 SCS 植入术后亚急性期铅迁移的发生率和程度，并报告铅迁移的潜在危险因素。

材料和方法

我们对 2020 年 1 月 1 日至 2020 年 12 月 31 日期间在单个学术中心接受 SCS 植入物的所有患者进行了回顾性图表审查。有关患者（年龄、性别、体重和身高）和手术因素（设备制造商）的信息，硬膜外通路水平和方法，以及植入式脉冲发生器位置）是从医疗记录中提取的。将术中成像与植入后不到 20 天获得的亚急性随访成像进行比较，以测量导线迁移距离。回归模型被拟合以确定引线迁移距离和潜在临床风险因素之间的关联。

结果

该研究共纳入 91 例（182 导联）。在植入后 20 天内，88.5% 的导线发生了迁移（86.3% 的尾部和 2.2% 的头部）。根据前后位 X 光片，仅具有尾部迁移的导线的平均迁移距离为 12.34 ± 12.19 毫米，在侧位片上为 16.95 ± 15.68 毫米。随着患者体重指数的增加，尾侧引线迁移增加相关（β 系数 0.07 [95% 置信区间 0.01-0.13]，p  = 0.031）。在整个队列中，一名患者 (1.1%) 因失去疗效而需要进行导线修正。

结论

在 SCS 植入后的亚急性术后阶段，大多数 SCS 导线向尾侧迁移，平均有两个导线接触。在决定最终引线放置位置时，了解这种预期的迁移和风险因素可以更好地在术中告知植入医生。在亚急性术后期间发现尾侧铅迁移的可能性很高，因此需要对我们领域的前沿进行精心设计的前瞻性研究。这将使植入提供者能够为术中导线放置做出明智的决定。