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

Plate/Paddle Electrode Migration

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

• Incidence: Surgical plate/paddle electrodes resist migration after encapsulation.
• Time to appearance of symptoms: immediate, i.e., before encapsulation
• Treatment: Non-invasively reassign contact combination if possible; if ineffective, revise electrode.
• Usual resolution and impact on therapy: Minor displacement usually can be addressed non-invasively; major displacement requires revision.
• Risk reduction: Some surgeons suture surgical plate/paddle electrodes directly to the dura, but this requires exposing a larger area, which is problematic, and might add mechanical stress.  Some use an anchoring/strain relief sleeve to secure the emerging lead wire to the spine.  Using absorbable sutures eliminates the continued focal stress that can be caused by non-absorbable sutures after the electrode becomes encapsulated.  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 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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