Practice Parameters for the Use of Spinal Cord Stimulation in the Treatment of Chronic Neuropathic Pain
Lead/Cable Failure
What is the incidence, time to appearance of symptoms, usual resolution and impact on therapy, and worst case adverse sequelae of electromechanical failure of the lead or extension cable following SCS treatment, and how can this risk be reduced?
- Incidence: rare
- Time to appearance of symptoms: variable
- Treatment: revision as necessary
- Usual resolution and impact on therapy: Surgical revision restores SCS therapy.
- Worst case adverse sequelae: Failure of the lead wire portion of an electrode assembly can require replacement of the entire assembly.
- Risk reduction: Avoid using extra connectors (a potential source of failure that adds mechanical stress to adjacent cable or lead wire). If extra connectors are used, locate them at or near existing points of fixation. Create service loops from slack, redundant cable or lead wire and place them in locations where they can provide strain relief (e.g., within the fibrous pocket beneath the pulse generator). Subject to patient preference and surgical judgment, avoid crossing mobile segments of the body with cable or lead wire, so as to reduce motion-stress from postural changes; for example, in patients with low thoracic electrodes, place the pulse generator in the flank or lateral abdomen at the same level as the electrode anchor.
| Strength of recommendation | Evidence source's/rationale |
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B = Recommended Uncertain validity, apparently useful |
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