Practice Parameters for the Use of Spinal Cord Stimulation in the Treatment of Chronic Neuropathic Pain

Percutaneous Electrode Migration

What is the incidence, time to appearance of symptoms, usual resolution and impact on therapy, and worst case adverse sequelae of percutaneous catheter electrode migration following SCS treatment, and how can this risk be reduced?

• Incidence: variable depending upon implantation technique
• Time to appearance of symptoms: immediate to decades
• Treatment: Non-invasively reassign contact combination if possible; if ineffective, revise the electrode.
• Usual resolution and impact on therapy: Minor displacement usually can be addressed non-invasively; major displacement requires revision.  After fibrous tissue encapsulation occurs, revision might be more difficult, e.g., requiring laminectomy or laminotomy.
• Worst case adverse sequelae: inability to recapture pain/paresthesia overlap
• Risk reduction: Applying silicone elastomer adhesive during anchoring has been reported to prevent longitudinal electrode migration.  (This is not necessary or possible with some anchors and techniques, and alternatives are under development.)  During system implantation, avoid increasing mechanical stress by avoiding unnecessary bends of small radius and superfluous connectors. Subject to patient preference and surgical judgment, avoid crossing a mobile joint or body segment with subcutaneous lead wire or extension cable; e.g., a thoracic electrode encounters more stress and strain if connected to an upper buttock pulse generator than if connected to a lateral abdominal generator.

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