Percutaneously Inserted Unilateral Lead Migration Salvaged with a Paddle Electrode

• Published in: Pain practice 2020-06, Vol.20 (5), p.544-549
• Main Authors: Oh, Byeong Ho, Kim, Hyeon Tae, Yim, Kyoung Hoon, Park, Young Seok
• Format: Article
• Language: English
• Subjects: lead migration; neuropathic pain; revision surgery; salvage; spinal cord stimulation
• ISSN: 1530-7085; 1533-2500
• DOI: 10.1111/papr.12871

Introduction Lead migration has been regarded as a frequent complication after percutaneous spinal cord stimulation (SCS). Thus far, repeated reinsertion of leads or replacement of paddle electrodes after removing percutaneous leads has been performed, but a salvage surgical technique using the remaining electrode has not been reported. Here, we describe a case in which unilateral lead migration was successfully treated with the insertion of a paddle electrode. Case Summary A 44‐year‐old male paraplegic patient with chronic neuropathic pain in the right leg and low back for 7 years underwent a percutaneous spinal cord stimulation procedure 5 times over 2 years because of repeated unilateral lead migration. The left lead underwent repeated migration and was difficult to reinsert due to epidural adhesion. After confirming the position and stimulation area of the remaining lead, we decided to insert another paddle electrode beside the remaining lead. We performed a T10 laminotomy and inserted a paddle electrode on the right side, using it in combination with the previous left lead. After surgery, the patient was satisfied with a wide coverage area. Discussion We recommend salvage additional paddle electrode insertion rather than removing both leads during revision SCS. This surgical method increases the possibility of covering the dorsal column (DC) of the spinal cord, is cost effective, and decreases the possibility of failing to cover dorsal column using the paddle electrode during open surgery because the remaining lead’s position and stimulation area guide the insertion of the additional paddle lead.