Incidence and Risk Factors for Spinal Cord Stimulator Lead Migration With or Without Loss of Efficacy: A Retrospective Review of 91 Consecutive Thoracic Lead Implants

Dombovy-Johnson, Marissa; D’Souza, Ryan S; Ha, Chris Thuc; Hagedorn, Jonathan M

doi:10.1111/ner.13487

Cited by 32 publications

(28 citation statements)

References 30 publications

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Section: Discussionmentioning

confidence: 99%

“…Dombovy-Johnson et al showed that within 20 days of implantation, 88.5% of leads had migrated (86.3% caudal and 2.2% cephalad) in 91 cases [ 23 ]. The mean migration distance for leads with caudal migration was only 12.34 ± 12.19 mm based on the antero-posterior radiographs and 16.95 ± 15.68 mm on the lateral radiographs [ 23 ]. This low rate of clinically significant migration, which required reoperation, is likely to be attributed to both purposeful cephalad placement and advances in lead programmability.…”

Section: Discussionmentioning

confidence: 99%

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Single Lead Epidural Spinal Cord Stimulation Targeted Trunk Control and Standing in Complete Paraplegia

Gorgey

Gouda

2022

JCM

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A 25-year-old male with T3 complete AIS A was implanted with percutaneous spinal cord epidural stimulation (scES; eight contacts each) leads and a Medtronic Prime advance internal pulse generator. The two leads were placed at the midline level to cover the region of the T11–T12 vertebrae. Five days after implantation, X-ray showed complete migration of the left lead outside the epidural space. Two weeks after implantation, reprogramming of the single right lead (20 Hz and 240 µs) after setting the cathode at 0 and the anode at 3 resulted in target activation of the abdominal muscles and allowed for the immediate restoration of trunk control during a seated position, even with upper extremity perturbation. This was followed by achieving immediate standing after setting the single lead at −3 for the cathode and +6 for the anode using stimulation configurations of 20 Hz and 240 µs. The results were confirmed with electromyography (EMG) of the rectus abdominus and lower extremity muscles. Targeted stimulation of the lumbosacral segment using a single lead with a midline approach immediately restored the trunk control and standing in a person with complete paraplegia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Single Lead Epidural Spinal Cord Stimulation Targeted Trunk Control and Standing in Complete Paraplegia

Gorgey

Gouda

2022

JCM

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“…Activation of the large-diameter fibers in the dorsal columns is thought to inhibit pain transmission via gating within the dorsal horn (Zhang et al, 2014) (Yang et al, 2011) however, several studies suggest that additional segmental and supraspinal mechanisms are involved in EES-induced analgesia (Gilbert et al, 2022). Variations in the effect of EES to control pain can be attributed to multiple factors, such as initial placement or later migration of the electrode contacts, patient position, and the functional state of the neuronal circuitry (Mekhail et al, 2022) (Pahapill et al, 2020) (Dombovy-Johnson et al, 2022a). Although lead migration can be confirmed through clinical imaging, there is currently no clinically available method to detect and flag the possibility of lead migration for EES automatically and continuously which would allow for decreased loss of efficacy.…”

Section: Introductionmentioning

confidence: 99%

Characterization and Applications of Evoked Responses During Epidural Electrical Stimulation

Verma

Romanauski

Lam

et al. 2023

Preprint

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Epidural electrical stimulation (EES) of the spinal cord has been FDA approved and used therapeutically for decades. However, there is still not a clear understanding of the local neural substrates and consequently the mechanism of action responsible for the therapeutic effects. Epidural spinal recordings (ESR) are collected from the electrodes placed in the epidural space. ESR contains multi-modality signal components such as the evoked neural response (due to tonic or BurstDR waveforms), evoked muscle response, stimulation artifact, and cardiac response. The tonic stimulation evoked compound action potential (ECAP) is one of the components in ESR and has been proposed recently to measure local neural activation during EES. Here, we first review and investigate the referencing strategies, as they apply to ECAP component in ESR in the domestic swine animal model. We then examine how ECAP component can be used to sense lead migration, an adverse outcome following lead placement that can reduce therapeutic efficacy. Lastly, we show and isolate concurrent activation of local back and leg muscles during EES, demonstrating that the ESR obtained from the recording contacts contain both ECAP and EMG components. These findings may further guide the implementation of recording and reference contacts in an implantable EES system and provide preliminary evidence for the utility of ECAP component in ESR to detect lead migration. We expect these results to facilitate future development of EES methodology and implementation of use of different components in ESR to improve EES therapy.

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“…This review is timely and relevant as it provides clinicians an updated appraisal of evidence for several clinical indications. In light of habituation [11] and loss of efficacy [12][13][14] from long-term dorsal column spinal cord stimulation, this review highlights yet another unique modality of neuromodulation that can be offered to patients to salvage analgesia, physical functionality, and patient satisfaction [15]. Finally, as researchers continue to elucidate the mechanisms of action from neuromodulation that lead to analgesia, DRG-S will be a primary focus due to the role of DRG neurons in pain transduction, afferent signal filtering, and windup phenomena [1].…”

Section: Introductionmentioning

confidence: 99%

Dorsal Root Ganglion Stimulation for Lower Extremity Neuropathic Pain Syndromes: An Evidence-Based Literature Review

et al. 2022

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Dorsal root ganglion stimulation (DRG-S) is a form of selective neuromodulation therapy that targets the dorsal root ganglion. DRG-S offers analgesia in a variety of chronic pain conditions and is approved for treatment of complex regional pain syndrome (CRPS) by the US Food and Drug Administration (FDA). There has been increasing utilization of DRG-S to treat various neuropathic pain syndromes of the lower extremity, although evidence remains limited to one randomized controlled trial and 39 observational studies. In this review, we appraised the current evidence for DRG-S in the treatment of lower extremity neuropathic pain using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria. The primary outcome was change in pain intensity after DRG-S compared to baseline. We stratified presentation of results based of type of neuropathy (CRPS, painful diabetic neuropathy, mononeuropathy, polyneuropathy) as well as location of neuropathy (hip, knee, foot). Future powered randomized controlled trials with homogeneous participants are warranted.

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Incidence and Risk Factors for Spinal Cord Stimulator Lead Migration With or Without Loss of Efficacy: A Retrospective Review of 91 Consecutive Thoracic Lead Implants

Cited by 32 publications

References 30 publications

Single Lead Epidural Spinal Cord Stimulation Targeted Trunk Control and Standing in Complete Paraplegia

Single Lead Epidural Spinal Cord Stimulation Targeted Trunk Control and Standing in Complete Paraplegia

Characterization and Applications of Evoked Responses During Epidural Electrical Stimulation

Dorsal Root Ganglion Stimulation for Lower Extremity Neuropathic Pain Syndromes: An Evidence-Based Literature Review

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